Oakes, Leonard TO I+N OF QUEE9\(,5BURy
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, '.r'EW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director Cr`}/�,C,� laIV
Name � crlv hfu Case
Date of Cremation
Time Cremation Started f / r ,
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Time Cremation Completed 1,1o4 jo rq,
Type cf Container .96j ARV 02 NO, G1-95,e�
Remarks :
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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:
Leonard Nelson Oakes male
(Name) (Sex)
3157 State Route 4 Hudson Falls NY 12839
(Street) (City) (State) (Zip Code)
who died on the 9th day of January 2002
at 3157 State Route 4, Hudson Falls, NY 12839
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Leonard L. Oakes, 26 Willow St. , hudson Falls, NY 12839
(Name) (Address)
Relationship to the deceased father
Name of Funeral Home Carleton Fueral Home, Inc
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,
Vwhethr such claims or demands are not wholly groundless, false or fraudulent.
68 Main St. , Hudson Falls, NY 12839
(Witness) (Address)
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� � 6L����� 26 Willow S , Hudson Fa11c Nv 12839
(Signature of Relative or Legal Rep. and Address)
Signed on this date: 1/10/02