Nadeau, Daniel OF
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WE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12844
(518) 745-4476 (518) 745-4477
( Funeral Director Fame �a —
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Dace Of Cremation
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Time Cremation Started_ : 00 —
Tame Cremation Completed
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Town of Queensbury
Pine View Cemetery and Crematorium
21 quaker Road,Queensbury, New York, 12804
Cemetery Office:(518)745.4476.Crematorium: (518)7454477
Authorization to Cremate
The undemlgnad requests and awes tees Pine view cramstwN+m,In scoordatoe with and Subject to No Rules and Raguletiorn to
aentato a*rwrtahte of
Daniel K. Nadeau Male
(Name) (SM)
150 Thornbtssh Road Mansfield T 06250
(Street) (0(b) (State) (ZIP Cads)
who dle0 on 19 t h day of July 2108
a. Crown Point, NY
(Place) bA&M)
Name end address of resamft IMnp romNe'or name of peraor►aAho t*V crernoWn:
Diana Nadeau 150 ThcrnbuahRead. Mansfi _1_d. CT 06250
(Name) ( )
Relations"to the doceaaed Mother
NernaofFuneral Clark. InC., 2310 Saranac Ave. , Lake Placid, NY
IMPORTANT: 12946
1 repraeent that to the beat or ry knowledge,the deceased(hoe)or(has no)pomnskmr,dad 11ator,bothry,bstte y pack,power
cog,rsdloseWe Impacted or.rad( **W dovtos In his or her body.(Chtys Ones)
I cm*to I two hAl pwMor and sulDort wlan to wrongs 1W the oremstim of the rert►alns and to dhect the disposhlon of the
Cremated remalne,drat tarry psreaeu l pooss000no have dther boon removod or may be destroyed.and agree to protect,defend and
save hannlase Pine View Crematorium from any and ell clekm and dernonds Wtome or elm egea wNrh may be.made spmMmt them
by common ofor connected with the aentatlon d saki nw aha r dirteaad.whelhar each cbbns or demands are or are not Wwly
Orourtdlecs,false or heutfulant
2310 Saranac_ Ave. , Lake Placid, NY 12446
(Wttneee) (Address)
X ZL 150 Thornbu6h Road. , Mansfield, CT. 06250
S pna um end Address of R*WM or Legal Reprssentathre)
Signed on thls dote: Tilly 2 Q, 2,0 0 8
DlapoalOon of Cnmwwd Ranalm
I hereby dlred Plus View CramstoAum to dhooae of the crsmeted romaire as failows:.
Mall to
0Uwwm o_Pknmapodfy. `C-pma i ns tQ by p1 clod t1A at the crematory by the
If pulvowtretbn of cmmeW remaUs Ls roqueated,check hwJx. family.
Ravla=ApdI 18,2007
212'd e6£2ses:oi 8£££ £2S eTS 'JNI N2dIJ 8 WWOZIJ £T:SO 8002-02-inf