Bradley, Ellen Mae (Sister Mary) OF
PU`1E YTE QUEE9\�52� UrRry
�' CEMETERY A
QV'�3C.EJt ROAD.
4 � CREMATORIUM
(518) 7 ��6 SBt�Y' NEW YORK 1280q
(518) 745.4-477
-Name Funeral Director g
r5 Case# Ley
date �� Cremation
Z
Time Cremation Started "O Z� b
U
T me Cremation Completed
3 :Z
Type of Container r
�t{ Ofi,((� 7
RemarKs c) pC11
z��op
T
Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road, Queensbury, New York, 12804
Cemetery Office: (518) 745-4476, Crematorium: (518)745-4477
Authorization to Cremate
The undersigned requests and authorizes Pine View Crematorium,in accordance with and subject to its Rules and Regulations to
cre the remai of:
ulgo T&- (, Female
(Name) (Sex)
242 Cloister
(Street) (City) (State) p Cam)
who died on 30th day of QptgmhQr- 20 08
at The Sisterhood of St Mary, 242 Cloister Wavy Greenwich, NY 12834
(fie) (Address)
Name and address of nearest living relative or name of person authorizing cremation:
Mother Miriam Willis
(Name) (Address)
Relationship to the deceased Mother Superior
Name of Funeral Home M B K i l mar P11nara 1 uomg,
IMPORTANT:
I represent that to the best of my krowledge,the deceased(has)or(has no)pacemaker,defibrillator or any other battery operated
device in his or her body. (Circle One)
I certify that I have 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 Balms and demands for loss or damages which may be made against them
by reason of or contested with the cremation of said remains as directed,whether such claims or demands are or are not wholly
groundless,false or fraudulent.
(Witness) (Address)
(Signature and Address of Relative or Legal Representative)
Signed on this date: DC� �T_a>ad 8
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mail to
Other arrangements-Please specify:
If pulverization of cremated remains is requested,check here
Revision:January 1,2006