Townley, Ruth T014/N OF QUEEVBURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral DirectorOf
Name 9d 7-HCase #
Date of Cremation
Time Cremation Started 6J r�.`��1!9//)°1 j
Time Cremation Completed r ✓�/
Type of Container
Remarks :
i
DISPOSITION OF CREMATED REMAINS
I hereby direct Pine View Crematorium to dispose of the cremated
remains as follows :
Mail to
Other arrangements - please specify : Will Pick Up
If pulverization of cremate remains is requested, check here X
POLICIES, RULES AND REGULATIONS
1. The crematorium will be open for cremations 5 days a week
7:00 A. M. - 3:30 P. M. Monday-Friday. No Holidays or Sundays,
arrangements can be made for Saturday. Prearrangements by
telephone for acceptance of remains is necessary.
2. Pine View Crematorium is located on the grounds of the Pine
View Cemetery, Quaker Road, Town of Queensbury.
3. An authorization for cremation properly signed by the nearest
next of kin or other authorized person stating that they do have
the power and authority 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 of
damages which may be made against them by reason of or connected
with the cremation of said remains and/or disposition of said
remains as directed, whether such claims or demands are, or are
not wholly groundless, false or fraudulent. This authorization
in addition to a regular burial permit must accompany the
remains.
4. All remains must be encased in a casket or suitable alternate
container. Caskets and containers must be of combustible
material. No styrafoam or plastic containers will be accepted.
5. The question relative to cardiac pacemakers must be answered
on the authorization to cremate form before the remains will be
accepted.
6. Unless other arrangements are made the cremated remains will
be mailed via Registered U. S. Mail within three days .of cremation
to the funeral home handling the service. There will be a $20. 00
charge for this service.
Cremation, Administration Costs and Recording Fee: Adult $175. 00
Children (age 13 months to 12 years) $ 100. 00 Infants ( stillborn
to 12 months) $60. 00
r .
TOWN OF GUEENSBURY
PINE VIEW CEMETERY
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:
Ruth Townley Female
(Name) (Sex)
18 Terrace Ave. So. Glens Falls, NY 12803
(Street ) (City) (State) (Zip Code)
who died on 20th day of June 19 94
at reseidence - 18 Terrace Ave. So. Glens Falls, NY 12803
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation :
Marion Whalen 1 Toms Point lane Apt. 9 J Port Washington, NY
(Name) (Address) 11050
Relationship to the deceased Niece
Name of Funeral Home Flynn Bros. , Inc. 13 Gates Ave. Schuylerville, NY
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or
has no pacemaker 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
uE/rn
al or frau lent.
13 Gates Ave. Schuylerville, NY 12871
(Address)
1 Toms Point lane
Apt. 9 J Port Washin ton, NY 11050
re of Relative or Legal Rep. and Address)
Signed on this date : June 21, 1994
TOWN OF OUEENSOUnY
pIW VIEW CEM JF"Y
9
CREMATORIUM
Rucker Road, 0ueensbury, New York 128e4
phone (519) Crema►terium 745-4417 or if no answer j
Cemetery 745-4476
AUTHORIZATION TO CREMATE
The undersigned requests and authorizes pine View CrematoriuM, in
accardence with and subject to its Rules and Regulations to
cremate the remains .oft
Ruth Townley Fema3.e
(Name) (SeK)
l8 Terrace Ave. So. Glens Falls; NY 12803
t8treet ) (City) (State) (Zip Codr)
who died on 20th, -- day of June 19 9
at __ ret�aidat��e - 18 Totrace Ave. So. Glens Falls NY 12803
(place) (Address)
Name and address of nearest living relative or name of person
authorising cr,emationi
Marion Whalen 1 Toms Point Lane Apt. 9 J Fort Washington, NY
(Name) (Address) 11bS0
Relationship to the deceased Niece
Name of Funeral Home Flynn Bros. , TnC. 1.3 Ganes Avn. Srhtiylerville, NX
i MpbliTpNT e
i represent that to the best of nay knowledge, the deceased has or
has no pacemaker in his or her body.. (Circle One)
I certify that 1 have the full power and authorization to arrange
for the creaation of the. remains. and to direct the disposition of
the ereaated. remains, that Any personal possessions have either,-
been removed or may be destroyed, and Ag►^06 t0 prot#Cti dvfehd
and save harmless pine View Crematorium from any whd all cIN10%
and demands for loss or damoges which may be Oade against them by
reason of or connected with the creM&A ion of said remains as
directed, whether such claim% dr. demands are or are not wholly
undl fa r..au lent.
3 Gates Ave. Schuylerville, NY 12871
n G) (Address) .
1 Tome Point lane
9 J Port Washington,tort NY 1105
(Signature of Relativ or Legal Rep. and Address)
Signed on this date ) J e 21, 1994