Hungerford, James rrn
PINE VIEW CEMETERY AND CREMATORIUM
QU,AICF.R ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745.4477
Funeral Director �' ����� A-0 iy
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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:
James M. Hum�erford mat
(Name) (Sex)
132 Pleasant Valley Rd . , Argyle, NY 12809
(Street) (City) (State) (Zip Code)
who died on the 8th day of January 2005
at Glens Falls Hospital , glens Falls, NY 19ROl
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Tammy Whiting, 12 First St , Hudson Falls , NY 12839
(Name) (Address)
Relationship to the deceased daughter
Name of Funeral Home Ga�-Ieten Funexa! H��
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or =hasno
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 reaso, of or connected with the cremation of said remains as directed,
whether uch claims or demands are not wholly groundless, false or fraudulent.
68 Main St . , Hudson Palls . MY 128'-Iq
Witness) (Address)
CiDa06,1nA AA 12 First St , Hudson Falls NY 12839
(Signature If Relative or heg I Rep. and Address)
Signed on this date: 1/10/05
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