Bruce, James (-rnWN OF QUEEVBU9�
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name_it�t,�=�°;
Date Of Cremation
Time Cremation Started
Time Cremation Completed
Type of Container �? � f1��i� M �
Remarks
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Town of Queensbury
Pine View Cemetery and Crematorium
21 Quakes Road,Queensbury, New York, 12804
Cemetery Office:(518)745-4476,Crematorium:(518)745-4477
Authorization to Cremate
The uidersigneci requests and auMarizes Pine view Crematorium,in acoordance with and subject to its Rules and Regulations to
cremate the remains of:
Mr. James Robert Bruce, Sr. M
(Nam) _.- (Sex)
614 Lower Hudson Falls NY 12839-
(Street) (city)(city) ( ) (Zip Code)
who died on day of 20
Residence Hudson Falls NY
at
(Place) (Address)
Name and address of nearest Wing relative or name of person aut hortzkV cremation:
Mrs. Zoe Bruce 614 Lower Wright
(Name) (Address)
Rekdkx#o to the deceased Wife
Name of Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the best of my laawledge,the deceased(has) no nrelaer,deflbrNhffor or any other battery operated
device in this or her body. (Circle One)
1 certify that I he"full power and aWrortaativn to orange for the cremation of the remains and to direct the disposition of the
cremated remains,that arty personal possessions have either been removed or maybe destroyed,and apes to protect defend and
save Ihetnnrless Pine View Crsanwrfurn from any atnd all dahns and demands for boor deranges vrl"may be made againd them
by reason of or connected with on cremation of sad!remains as directed,whether such ciab s or demands are or are not wholly
,false
f
(Address)
(Signature ajJdAdftw of Relative or Leo Representative)
Signed on fiis date: 2dtom
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of fie aemeted remains as kdows:
Men to
Other arrangements-Please specify:
If pulveraation of cremated remains is requested,check hers XX
Revision:January 1,2006
OhL._