Maxam, Ethel �O O QUEE9�5OUrpW �
E VIEW CEMETERY No
WAXER ROAD, CREMATORIUM
Q�ENSSURy� NEW YORK 12804
(518) 745-4476 (518) 745-4477
Name ��ti Funeral Director f}�m cr
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C a s e# � +
Dace Of Cremation
T ;m D
e Cremation Started
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T , me Cremation Completed l:Zb Q
Type of Container ee
Remarks
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um of Owens!v
alp@VWw CWndwMW Creaudodwn
21 tiadw Road.Queestituy.Mm York, 12804
`WaOWY Offlm:(518)7454476.CrotMWum:(518)7454477
Autfxxbxdm to Cremate
The unc*signW mqugo 8r4 wA wtms p1w View CMMMOJ t.bt 8=lds=vAh wd sui ject to its Rules and Regulations to
cremate the remains of:
Ethel G. Maxam Female
(Name) (sex)
61 Chestertown, NY 12817
(Street) MY) (S>ate) (zip Cade)
wAv dW.on 218 t� days February 20 08
at Glens FallsRospital
(Pleas) (Address}
Name and address of nearest 9vvV relative or name of person aLdwizkg cremation:
`"Tvvz--nMk4.,j -7 Fs �? gza7s 2� c HE37d2�x✓✓� �i�
(Namo) (Address)
Reladonshtptothadeceesad . Daughter
NamaofFuneraHom& Alexander-Baker Funeral Home
IMPORTANT:
I repcesem that to the bast of my iln*490g%the deceased goo or pm Ito)pacemaker,desbriYator,battery,battery peck,power
cell,radioactive bmptant'or redbecOve davioe In his or her body.(Cide One)
I sanity that I hams U patwer aid WAorbodan tD enarge for the awntion of to retnakis and to dawt the disposition of the
«emceed remakts,tt)pt: gotieleB9lorts have aKW U---wired or ems►be.dowayed,and agree to protect,defend and
save ham ao-P tIF'e�Vfew f5orrr erg►and a0.daims and flamartds for loss or denrapes which may be merle them
lbby mot a� said ceinetiri as dtreded.wbeMrer audt claiirts or dernwWs are or are not wholly
(Address
�-_------- of Relative oc t�agal ReptNe)
SW*dontwdats: February 22 , 2008
uisposition of CremeW Remakes
hereby dnX:t Pk*View darmlpd=to dispose of the c emaked nmakcs as follows:
Mail to
ottwaaangernents-PteaeaspeW. Funeral home will pick up cremains
If pcdverbstlon of cmawled remake Is nquecsad,check tore X
Revision:Apd 18,2007
Policies, Rules and Regulations
1. Pine View Crenuftiurn is located on the Wa mde of Pine View Cemetery.The
c remakwium operates. �
throb F 7,00#m_19 3:30pm. Prior telephone
arrang�nant�'fortliei�"o�n'���wrwary.Preerrangemer>is�e
necessary for overdue or Sattuday c emadons.
2. A 'AuduAtation to Cremate'form signed by the nearest netd of kin is necessary stating
OW they do haws the power and allbcOy to arrange for the cremation of the remains
and to direct:the dispoekion of the cna�remains,that any personal pions
have either been rerrw-fed or may be destroyed and agree toF.pnnteM defend and save
harmless Pine View Cemetery and Crenneborbunn from any and all claims and demands
for loss of damages which may be t6nn by i�son of or corvia de d with
-the cremation of said remake and/or disppskion of said remake as directed,whether
such claims are,or are not wtwNy gromkikim fte orl+AudL&nt.This authoriratktin
addidon to a regular burial permit must accompany the rename.
3. All remains must be In a casket or suitable akernalle amuniner. Caskets and containers
must be of a combustiMe malarial.No styrakm or pbeft=MkWMv N be accepted.
4. Any cardsac pacerrtak+ers,defbiilacas,babbry,b 3MY POCK Per cell, radioactive
implard or radioec Ws.tlevbe must be f+annowtd*Om the body before any remains will be
accepted. . , - . .
5. Cr+emtations will be.completed deyQ2 hours)'of receipt of the
MIii11b d'- ...
Btxi�Tom,,, Autha ' . '1'tte cxrta�oed wiA
be mailed vW RegisbjW U.S: daysota+amelfiont b the*Newel home
handling the service unless other amergemertl`e are made.There vM be a$30.00 charge
for this service.
6. Cr8ffkl M.AdrnkftVa i m Coots and Repo Few
Adult .00
Children (age 13 months to 12 years) $130.00
Infants (stillborn to 12 monf) $130.00
overtime Crt>rinations(weekdays) 5480.g0
Saturday Cremations $480.00