Geddes, James 1O`m'N OF QUEENB!]
�..L-�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director �,3L�-`Su�= �
Name_ ,Tc,mrS 6--445
Case# GIs�
Date Of Cremation d
� r
Time Cremation Started
Time Cremation Completed V 0 PrI
Type of Container F- 'J r'A
Remarks
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OCT-10-2006 13:40 FROM THE MAIL ROOM TO 18022879108 P.02/02
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TPINE O OF Y
VIEEW CEMMR
a
CREMATORIUM
purr(toad. Queenesury,New York 12804
Phone(618)Grenstorlum 146r44TT(it no answer)
Cemetery TAS-4475
AUTMORIZATION TO CREMATE
The undsnb
nad rpuasts and suthodzee Ping
vI Cramatorlum,In sccerdance"0 and publed
10 Its Rules end Requfaabns to cremate the rerrelns o.
Male
James T. Geddes
(SEX)
(NAME)
8 Elizabeth Street, Whitehall NY 1 (9TAYB) (Zip CODE)
(s E (GITr)
�a
6 th day of o _SODA--
who deed
qT
a Rutland Regiotlal medical Center-
(PLACE)
Normand address of neiraa!Living relative or nerns or person authorizlny crennaUon:
'Rargaret Geddes- 776 Fast 4th Ave. Durango, Qd 81301
�: - paaghter
ReWtlorttihlp'to deoeessd
•.-••_Roberts-Rubin F.H. PO Box 181
Netr+e of FYrlar.1 Home Ppult�ctie VT
IWORTANT beet of my krrowledlis•the deceased Jai orttr,s nsn,paarielar In his or her
I represent Owl to the
body. (CIRCLE
1 oero.that I•have ttie dull power and aunmstni tnh to amrpeMia the PC eselons hw Yellher 000 Of the me"
w drkt tie dispoedlon or the aremat" . ateot,defend and same herrttlees Pltta
iew
removed or may be dewoyed,and agree to pr wttich mtigr be rnede
Greenitorlum from:any Ind all claims Ind Qemands for lose or dtmr"Ma as
anal ititYhem bji ram ehr+of ur connecledw�ht gro�fNI10n,f Of GO'd
alse or t auduteant direotao,wChethor
such olarms or deA�►aflds are or are not
�`ICY boto
cc)
8130
( (ADORE 0) co
776 East 4th Avenel ADDRESS)
81301 .
NA 11 LATIVE OR L GAL R F_ .
X $lend on this dats:�
' 97i
P.01
OCT-10-2006 12:57
- TOTAL P.02