Lafay, Joseph Anthony TOWN OF OUEENSBURY �
PINE VIEW CEMETERY
a
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 745-4477 or if no answer
Cemetery 745-4476
AUTHORIZATION TO CREMATE
The undersigned requests and authorizes Pine View Crematorium, in
accordance with and subject to its Rules and Regulations to
cremate the remains of:
Joseph Anthony LaFay Male
(Name) (Sex)
Apt 3G, Earl Towers Hudson Falls, NY 12839
(Street ) (City) (State) (Zip Code)
who died on 8th day of December 19 96
at Glens Falls Hospital 100 Park Street Glens Falls, NY 12801
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation:
Mr. David J. TaFay 31 Pinewood Rd. , Queensbury, NY 12804
(Name) (Address)
Relationship to the deceased Son
Name of Funeral Home Carleton Funeral Home Inc.
IMPORTANT:
I esent that to the best of my knowledge, the deceased has or
has no acemaker in his or her ,body. (Circle One)
I certify that I have the 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 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.
68 Main St , Hudson Falls , NY 12839
(Witness) (Address)
c--,„ � Q C . (7 31 Pinewood Rd . , Queensbury, NY 12804
(Signature of Relative r Legal Rep. and Address)
Signed on this date: a1 15C`