Brownell, William PLNE Xq Qu u���8
�l�h3CPR �TERy A� CREMATORIUMS
CEht
ROAD. QUgpNSBURY.
(518) 745.4.476 KEW YORK 12804
(S18) 745'.4.4
dam I � Fvneral Director
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^d ' e � ! Crematl.on CeseY
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• Te ; remacion Started
T Cremation Completed
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Town of Queensbury
Pine View Cemetery and Crematodum
21 Quaker Road.Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745.4477
Authorization to Cremate
The undersigned rerf m is and autlWtms Pk*Vtew CrOfflS or um,In aa=darroe v*h and U#9d to Its Rules and Reguletiorrs to
cremate the rerneft of:
William Michael Brownell M
(Name) (Simi)
Village Glens Falls NY 12801-
(Stnaet) (City) (State) (ZIP Code)
Y*w died on dayd 03/24/2009 20_
at Glens Falls Hospital Glens Falls NY
(Piece) (tea)
No. and eddr+an d rta, gal living relat w or named person audxwbkV cremation:
Gail Brownell Village Green Apt 101, C, 1-Pn S
(Name) (Address)
Reiatlons!Iip to the deCeaeed Wife
Name of Funeral Kne Carleton Funeral Home, Inc.
IMPORTANT:
i represent the tD rite best of my latvwladgo,the deoeaaed(tree) na) maker,deelbrillOw.battery, y Pam.P0*W
ceA radloecdve In qft t or radioadive daubs in his or her body.
1 cerWy first I gave U power and sutlwri¢atlon to arrange for the c remakin of the remains end to dkw the diepoeltbn of the
cremated rarnains,do any personal poeeeea1, , , he"ellIm bean removed or may be deft ayed,and agree to prded,defend and
save harmless Pine View CrUMiorium from Wry and all AM s and demands tior bee ar deranges wtticit maybe made agaktal them
by ree mn d or caxtecled wth lire cromadm of add ttttrnkta as dkwled,wAetlter auch dakt+s ar dertrWtds are or are not whDly
false or*auduMIL
D 68 Main Street, Hudson Falls, NY
V� ( )
X LLj,,, 77A D4 Lg�'UVillage GreenP�. b (aws (�
(Sipnsaae mid Afteas�^ of l*tWt w orr LLegal R
te: ePreser>t�ve)
Signed on this da y-s—
DbpoekW of Cremated Remains
I hereby direct Pine View Crernaborkrm to+ of the cremated remains as 1bllowa:.
Mail to
Other arrangenrerm-Please spedryr:
If pulver¢Wion of Cremated remains is mWeNed,dedr here XX
P&vWkmt Apr118,2W7