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Bradt, Harold
F QUEE9�5BU20,,- PLNE V'F-W CEMETERY AND CR QUAKER ROAD, QUEENSB EMATORIU URY, NEW YORK 12804 (518) 745-4476 (518) 745--4477 ,Fame Funeral Director / �©[d, d IY s Case Date Of Cremati.on Tame Cremation Started Pt Time Cremation Completed Sc} p. Type of Container Remarks C� 1 ao ve op f� Tom of Queensbury Pine View Cemewy and Crematafum 21 Quaker Road,Queensbury, New York, 17804 Cemetery Office: (518)745-4476, Crematorium: (518)745-4477 ' Authorization to Cremate The undWS%p ed re genets and a Lim horiaea Pine View Cremeftium,in socordenoe with and subjed to ks Rubs and Regubtiorts to cremate the remains of: Harold Bradt M (Name) (SOX) 3 Mill Road, Cossayuna, NY 12823 (Street) (CRY) (SN") (Zip Code) rrtto dad on day of 0 3/14/2 0 0 8 20_ at Glens Falls Hospital Glens Falls NY (ftce) ( ) Name and addretas of nearaet fivktg rehOw or now of person auMorb*g aemadom Heather McKernon 3 Mill Road, Cossayuna, NY 12823 (Name) (Address) P40810MOV 10 ttre deCea9ed Daughter Name of Funeral lkx. Carleton Funeral Home, Inc. IMPORTANT: I regr+esrrk that to the boat of my knaMedge,ttte deoeaaed(tm)or Om no)peoeme1w,defb Heft,bWerY,baWy pa*power cel.nmhowd"implant or nwOoscxive device in his or her body.(Ck+de One) I ow*that i wave AA power and audwdzetlon to arrange for the crernaka of the remeft and to dkW the dispoeeian of the aarneW remakrs,that any pwoonM posevesbns have 9M ar been removed or maybe destroyed,and agree to prolect defend and Sara hen niam Pk*Vk m Crometorkm from trry and aN tisirrts oW dernends trot bee or dewlaps whth may be made etgttirtet them by mown of or connacwd wkh dre cnwwdon of add ramai is ee dkeaed,*Nadler such dah, or ri—a de are or ere not wholy Ww r?bwtn 68 77j,,, ain Street, Hudson Falls, NY ? (Address) k C� � and Abftbsof ri i or egef R eeprea **ve) Signed on this dace: t -7 y— 9 DbpoWon of C:ramated Remakte I hereby direct Pkte view cmmatorwm to dkgtose of ft c nwq tad remebw as fo&ms:. Mail to Other arrangements-Please spec fy: j tf put wketion of cremated remains is mWeeted,check here XX Recision:AprN 18,2007 i