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Clancy, John rT-nWN OF QUEEN5BU.�Y PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NTW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director ro o MIFF- �1 ,�L) Name ;�bkiq CLnwr `ef Case # Date of Cremation Time Cremation Started Time Cremation Completed 1 62 d '� Type cf Container l��a1 (3Qy�l2C� '��' A51 Remarks : All q'_..J0 J C' Whispering Maples Memorial Gardens lne. P.O. Box 1 63. Ellenburg Depot, New York 12935 Call 24 Hours: 518-594-7500 AUTHORITY TO CREMATE (This Authority signed by the proper relative or legal custodian of deceased, together with Burial Permit, must be filed at the office of Whispering Maples Memorial Gardens Inc., before cremation may take place.) hereby request and authorize Whispering Maples Memorial Gardens Inc. to cremate the remains of: ❑ Female John Clancy ® Male (NAME) 420 Old Military Rd , Take P1 ao�, rTv i �AL�h (STREET-CITY-STATE-ZIP CODE) who died on the 29 day of January , 20 02 , at the age of 88 I represent that, to the best of my knowledge, the deceased has no pacemaker in his or her body. DISPOSITION OF CREMATED REMAINS I hereby direct Whispering Maples Memorial Gardens Inc. to pulverize the Cremains, if necessary, and to dispose of the remains as follows: Mail to: Fortune—Keou h Funeral Home Inc (FUNERAL DIRECTOR OR FAMILY) 40 Church St . , Saranac Lake NY 12983 (STREET-CITY-STATE-ZIP CODE) Other Arrangements (PLEASE SPECIFY) I certify that I have full power to give the above Authority to Cremate and to direct the the above Disposition; and I agree to protect, defend and save harmless Whispering Maples Mem— orial Gardens Inc. and the Funeral Director from any and all claims and demands for liabilities, losses and/or damages which may be made against them, or either of them, by reason of, or connected with, any action taken by them under the above Authority to Cremate and/or Dis— position ted and directed by me whether such claims or demands are or are not groundless, fa or ud e �ZE WI NESSSIG/NAIVE OR LEGAL REP. �1 S Tip FUNERAL DIRECTOR RELATION TO r�F( EASED OR AUTHORITY TO SIGN a Andrew J. Fortune Jr Marie Kirby, 200 F St , NW, Apt 22Lhf�. DC 20006 ADDRESS A R SSc/ 4 G" C ifi,9.�'G i1 ST /� F/,7 Note: All Cremains are returned in a plastic bag in a cardboard box unless other arrangements are made. Important: The Funeral Director should make adequate inquiries of the deceased's medical doctor and relatives and any hospital involved to assure that deceased has no pacemaker im- planted in his or her body. If any pacemaker was implonted, it must be removed before the body is delivered for cremation. Whispering a e Mpls M IA emorial GarderisIn' c. ( P.O. Box 163. Ellenburg Depot, New York 12935 Call 24 Hours: 518-594-7500 AUTHORITY TO CREMATE (This Authority signed by the proper relative or legal custodian of deceased, together with Burial Permit, must be filed at the office of Whispering Maples Memorial Gardens Inc., before cremation may take place.) I hereby request and authorize Whispering Maples Memorial Gardens Inc. to cremate the remains of: E7 Female John Clancy (2F Male (NAME) 420 Ol.d. military Rd . , Lake Placid , T 12.94E (STREET-CITY-STATE-ZIP CODE) who died on the 29 day of January , 20 02 , at the age of 88 1 represent that, to the best of my knowledge, the deceased has no pacemaker in his or her body. I DISPOSITION OF CREMATED REMAINS I hereby direct Whispering Maples Memorial Gardens Inc. to pulverize the Cremains, if necessary, and to dispose of the remains as follows: Mail to: Fortune—Keough Fuileral flonte Inc (FUNERAL DIRECTOR OR FAMILY) 40 Church St . , Saranac Lake , NY 12983 ISTREE,T-CITY- AT*'Tt-Tt P--C'bOE) Other Arrangements- (PLEASE SPECIFY) I certify that I have full power to" give the above Authority to Cremate and to direct the the above Disposition; and I agree to protect, defend and save harmless Whispering Maples Mem— orial Gardens Inc. and the Funeral Director from any and all claims and demands for liabilities, losses and/or damages which may be made against them, or either of them, by reason of, or connected with, any action taken by them under the above Authority to Cremate and/or Dis— positioa,-gt�ed and directed by a whether such claims or demands are or are not groundless, fajsf or >suclu WITNESS SIGN [IRE OF RELAfIVE OR LEGAL REP. FUNERAL DIRECTOR RELATION TO nFC'EASEo-bR AUTHORITY TO SIGN y M a r i e K i r b -10D F. St. ��, )t.Z`'1 :,last 1. x 2Ct i Andrew J . Fortune Jr . �' ADDRESS AD RE S Note: All Cremains are returned in a plastic bag in a cardboard box unless other arrangements are made. I Important: The Funeral Director should make adequate inquiries of the deceased's medical doctor and relatives and any hospital involved to assure that deceased has no pacemaker im- planted in his or her body. If any pacemaker was implanted, it must be removed before the body is delivered for cremation. Name __ Case Number Date of Cremation . __ 20 A.M. Time Cremation Started -__._ _— P.M. A.M. Time Cremation Completed _ P.M. Type of Container Remarks: Signature of Operator � w e.Whispering risa leMemoraar de 5- P.O. Box 163. Ellenburg Depot, New York 'I 2935 Call 24 Hours: 518-594-7500 AUTHORITY TO CREMATE (This Authority signed by the proper relative or legal custodian of deceased, together with Burial Permit, must be filed at the office of Whispering Maples Memorial Gardens Inc., before cremation may take place.) 1 hereby request and authorize Whispering Maples Memorial Gardens Inc. to cremate the remains of: ❑ Female John Clancy (3Male (NAME) 420 Old Military Rd. , Lake Placid NY 12946 (STREET-CITY-STATE-ZIP CODE) who died on the 29 day of January 20 02 , at the age of 88 1 represent that, to the best of my knowledge, the deceased has no pacemaker in his or her body. DISPOSITION OF CREMATED REMAINS I hereby direct Whispering Maples Memorial Gardens Inc. to pulverize the Cremains, if necessary, and to dispose of ,the remains as follows: Mail to: Fortune—Ke6ugh Fufieral Horne Inc (FUNERAL DIRECTOR OR FAMILY) 40 Church St. , Saranac Laket NY 12983 (STREET-CITY-STATTE=>Z'iP•C6UE) Other Arrangements- (PLEASE SPECIFY) I certify that I have full power to' give the above Authority to Cremate and to direct the the above Disposition; and I agree to protect, defend and save harmless Whispering Maples Mem— orial Gardens Inc. and the Funeral Director from any and all claims and demands for liabilities, losses and/or damages which may be made against them, or either of them, by reason of, or connected with, any action taken by them under the above Authority to Cremate and/or Dis— positio�ed and directed by me whether such claims or demands are or are not groundless, fa or f udu f , WITNESS / SIGNIIRE OF RE - IVE OR LEGAL REP. ..sl5 tF/1 FUNERAL DIRECTOR RELATION TO nFC:EASED OR'AUTHORITY TO SIGN a Andrew J. Fortune Jr. Marie Kirby, 20D F. St., I+W, Apt.221, DC 201116 ADDRESS AD RE S �� Note: All Cremoins are returned in a plastic bag in a cardboard box unless other arrangements are made. Important: The Funeral Director should make adequate inquiries of the deceased's medical doctor and relatives and any hospital involved to assure that deceased has no pacemaker im- acemaker was implanted, it must be removed before the body planted in his or her body. IF any p is delivered for cremation. ,