Denton, James SOWN OF QUEEN,5BURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director/74-)E�—
x/9��,�
Name .���j Case # �
v
Date of Cremation
Time Cremation Started
Time Cremation Completed JI/M `
Type of Container ���/9 �
Remarks : i`' /
I
TOWN OF QUEENSBURY
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 745-4477 or if no answer
Cemetery 745-4476
AUTHORIZATION TO CREMATE
The undersigned requests and authorizes Pine View Crematorium, in
accordance with and subject to its Rules and Regulations to cremate
the remains of:
James Denton Male
(Name) (Sex)
(Street) (City) (State) (Zip Code)
who died on the 28th day of Oct,nbpr 2000
at His Home
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation:
/��,✓n�>,�( -. _166Y 1#46V Ste, G.A276v1 13A6 ,Al-q /2-eTs—
(Name) (Address)
Relationship to the deceased ,Sy�
Name of Funeral Home Alexander Funeral Home, Inc.
IMPORTANT:
I represent that to the best of my knowledge, the deceased Jb@@3jK
has no pacemaker in his4@Ldy. (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 uch claims or demands are or are not wholly
groundles f lse fraudulent.
( itne s ) (Address )
( Signature of Relative or Legal Rep. and Address )
Signed on this date: 10/29/00