Cronkhite, James R. 50tun U ueeno ary.
Owl f IPJE VIEW CEMCTERY acid CREMATORIUM U
QUAKER ROAD, QUEENCQURY, NEW YORK 12801
(518) 798 4 7 2 G
(5I8) 793-9777
Funeral Dirictor zit loll
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DaLe of Cremation
Tim Cremation Started At
Time CremaLion Completed qo ll 7/7 / ) ,
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j TOWN OF QUEENSBURY
PINE VIEW CEMETERY
&
CREMATORIUM
Quaker Road, Queensbury, New York 12904
Phone (518) Crematorium 798-4726 or if no answer Cemetery 793-9777
AUTHORIZATION TO CREMATE
'f Ise undersigned requests and authorizes Pine View Crematoriums In accordance with and
subject to its Rules and Regulations to cremate the remains oft
Name
Sex
Street Cit
y State ZIp Code
who died on
day of 19
at
Flacei Address ——
Name and address of nearest living relative or name of person authorizing cremation:
Name Address
Relationship to the deceased
Name of the funeral home
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or has no pacemaker In his
or her body. (CIRCLE ONE)
I certify that I have the full power and authorization to arrange for the cremation of the
remains and to direct the disposition of the cremated remains, that any personal possessions
have either been removed or may be destroyed, and agree to protect,.defend and save harmless
Pine View Crematorium, from -any and all claims and demands for loss or damages which
may be made against them by reason of, or connected with the cremation of said remains
as directed, whether such claims or demands are, or are not, wholly groundless, false or fraudulent.
Witness (Signature o Relat ve or Legal Rep.
Address
Address
Signed on this date
TOWN OF QUEEN38URYa �
PINE VIEW CEMETERY
do
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 798-4726 or If no answer Cemetery 793-9777
AUTIiORIZATION TO CREMATE
The undersigned requests and authorizes Pine View Crematorium, in acc6rdance with and
subject to its Rules and Regulations to cremate the remains of:
James Reynolds Cronkhite male
Name Sex
Fort Hudson Nursing Home , Fort Edward , NY 12828
Street City State Zip Code
who died on 1 3 t h day of August 19 92
at Glens Falls Hospital , Glens Falls , NY
Place Address ——
Name and address of nearest living relative or name of person authorizing cremation:
G . Ferris Cronkhite , 516 Ellis Hollw Creek Rd , Ithaca , NY 14850
Name Address
Relationship to the deceased brother
Name of the funeral home Carleton Funeral Home , Inc .
IMPORTANT:
I represent that to the best of my knowledge, the deceased hw& has no pacemaker in his
or her body. (CIRCLE ONE)
1 certify that I have the full power and authorization to arrange for the cremation of the
remains and to direct the.disposition of the cremated remains, that any personal possessions
have either been removed or may be destroyed, and agree to protect, defend and save harmless
Pine View Crematorium, from any and all claims and demands for loss or damages which
may be made against them by reason of, or connected with the cremation of said remains
as d ected, whether such claims or demands are, or are not, wholly groundless, false or fraudulent.
Witness
S gnature of Relative or Legal Rep.
Address
on Falls NY Ithaca , New York
Address
Signed on this date ✓ Z