Brady, James T'O 2�'� OF QUEE9��(50U(��/'PINEETERY ANE YIEW CEM �-J
D CREMATORIUM
QUAXER ROAD, QUEENSBURY NEW YORK 17804
(518) 745.4476 (518) 745*-4477
Funeral Director ^
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TOWN OF OUEENSWRY
PINE VIEW CEMETERY
8
CREMATORIUM
Quaker Road, Queensbury, New York 12504
Phone (518) Crematorium 745.4477 (if no answer)
Cemetery 745-4476
AUTHORIZATION TO CREMATE
The undersigned requests and authorizes Pine View Crematorium, in aooardance with and subject
to its Rules and Regulations to cremate the remains of
James Guy BradX Male
(NAME) Lt (SEX)
The Landing of Queensbury, 27 Woodvale Road, Qupensbury, New York 12804
(STREET) (CITY) (STATE) RJP CODE)
who died on 27th day of March 20 07
at Glens Falls Hospital, Glens Falls, New York I
(PLACE) (ADDRESS)
Name and address of nearest riving relative or name of person authorizing cremation;
Mr. James F. Brady, 494 Fairy Lake Road, Moriah, New York 12960
Relationship to deceased Son
Name of Funeral Home Connell, Dow &_.D_ay enrnrhy Tnr ^T
IMPORTANT
I represent that to the best of my knowledge, the deceasedxaC as pacemaker in his or her
body. (CIRCLE ONE) �
I certify that 1 have the full power and authorization to arrange for the cremation of the remains and
to direst the disposrtJon 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
such claims or demands are or are not wholly groundless, false or fraudulent.
G� -P0,Z 0x 2 v9y FC-A►2 4Lk-. 2J 1 IZ0 3/zy/o -
t(SIGNATIrF
(ADUR SS)
Oy
RELATIVE R LEGAL REP. D ADDRESS)Signed on this dat g �'
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03'30,,2007 09:58 FAX 6075479345 CD&D FUNERAL ROME 40 001 t
03/30/20137 09:46 B02-453-4521 KIM�ILL OFFICE SVCS PAGE 02/02 I�►p
'70WN OF OUEENSSUR`r "I
PINE VIEW CEMETERY
ti
CREMATORIUM
otialker Road, ❑ueenstiulY, New York 1f3D4
Phone(516)Cfematorium 74"477 (if no answer)
Cernetary 745-475
AUTHORZATION TO CREMAre
The undarblgMed reVests and atnhorizas Pir+e blew rterTlaluritirn. in a rdance with and svbjec(
to itg Rules er1C Regulations to cre nwte he remains of
.James Guy Br;kdy
Male
(NAME)
(SEX)
Ttia Lxiad I,T1 ofQueertsbury, 2 7 Woodvale Road eensbux , New York i i$04
(STR 'T) (CITY) (STATE (ZIP CfS00
M'to died on 27th day Of klatch 2� 07
at Glens Val3s Has isa1, GZeus t+a1]e New York
(PLACE) [ADDRES5
Name and address of nearest riving relative or name of pe15W authorting aefnatiorr.
Mr. dames F. Brady, 494 Fai Lake Boa Mcr3ah 'em York 60
RetaWnship to deceased Soa
Narne of 5u I
r7eral Horne Cor�mel
IMPORTANT
I represent that to the best of my knowledge, the decease
body, (CIRCLIE CNE) 1 paoernaker in his or her
I certify that I have the full power and authorizz9a s to aaarVe for tt WVM4nn of the rerimbs and
to dimpd the(fispasition of the OWMIed remains,ttrat aM'Personal pacwsslons hate either heart
removed or may be dosftyed,and agree to ported,defend and save harrdess PtIe YRew
.Grermturium from any and 0 cbihns and demm0s br km or darfmges whkh may be made
against them by reason of ce connected wb the cremativrt of safd rentalns its dined, whether �
sLm;h claims or demands are or are ptlt WF011y graWWless, false or ffaudlutent
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(SIGNAT PteLATIVE LEGAL_REP, D ADDRESS
Signed on this date: 'g a — --
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