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Name
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Date of Cremation
Time Cremation Sfarted i_�L� �� _ __�_.•
Time Cremation Completed _ _` P/
Type of -container
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I,the undersigned,the next of kin of . . . . . . 2G�P -f9•�� *��!. .:. . . . . . . . . . . . . . . . . . . . . . . . . . . .
deceased, do herby certify that I have full power and authority to arrange for the Cremation of the Remains of said deceased and to
direct the disposition of the Cremated Remains and I hereby agree to protect,defend and save harmless The Troy Cemetery Association
ano/or The Gardner Earl Memorial Chapel and Crematorium from any and all claims and demands for loss or damages which may be
made against them or either of them by reason of, or connected with, the Cremation of said Remains and/or the disposition of said
Remains directed by me,whether such claims or demands,are,or are not wholly groundless,false or fraudulent.
WITNESS .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . SIGNED . �.e . . .(). . . . �. . . . . . . .
Next of Kin_
Street and Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Street ?a�d Number . . I. . . . . . . . . . . . .
City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . city . �. .� .�. . . . . . . . . . . .
State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
State . (Ra'% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Receivedby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . . .
Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Not responsible for errors from phone orders.
Remains will not be accepted for Cremation unless delivered in a combustible casket.
REFUSAL OF CERTAIN CASKETS
The association reserves the right to refuse cremation when the remmins are in a casket
made of fiber glass,plastic,metal or other incombustible materials;OR any incom-
bustible material or substances placed within the casket that would be injurious or
damaging to the cremation chambers OR the operators thereof.
The funeral director in charge of the remains will be held responsible for any damages
caused by disregarding the above restrictions.
Hours: 9:00 A.M. to 4:30 P.M.daily except Sundays and Holidays,Saturdays until 12
P.M. An additional charge of$20.00 for each half hour will be made when bodies are
received outside of these hours.
Saturday afternoon services$80.00 additional.
No Cremations on Sundays or Hoi'idayrs —--
Unless the remains are called for within thirty days(30)from date of cremation,they will
be shipped direct to the Funeral Director responsible for the body,unless definite arrange-
ments for disposition have been made.
Prices Effective June 1, 1976
Cremation and Recording Fee $110.00
ADDITIONAL SERVICES
Metal Shipping Container . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
Carton& Packing Fee for Shipping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
Parcel Post& Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . minimum
Temporary Storage of Cremated Remains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Per mont .0
Annuall 4.
Perpetual Memorial Niches for Cremated Remains. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 u
TERMS: All charges must be paid upon placing of order or at the time of Cremation.
Burial Permit and this Authorization must accompany the Remains as no Cremation will take place until
these rules are complied with.
The Gardner Earl Memorial Chapel and Crematorium
opersW by
5M-5-76 TROY CEMETERY AMMIATION
The M IMI Chapel and Crematorium
operated by
TROY CEMETERY ASSOCIATION "OAKWOOD„
PHONE 272-7520 CREMATORY—OAKWOOD AVE. TROY, N. Y. 12180
AREA CODE 518 OFFICE—COR. 101ST ST. AND 7TH AVE.
AUTHORIZATION TO CREMATE
No.......__................._......................... JUNE 1, 1976_ Date.......... flf' ..............................
Name of Deceased . .._.... ................: ll. 1 :.......----•----...... .Sex............... ....
Residence
....../ .-. ...
City or Town St to
Single............. ................. Married................................. Widow................................. Widower.............................. Divorced...........................
Age—................, �...............I... Years.......................................... Months.......................................... Days
Place of Birth ........... "'..rz . d4..............................=ea2 .,.........Date of Death..
Placeof Death .......................................................................................................
Street, City and State
Name and full address of nearest living relative or name of person Authorizing Cremation
....... .....Y.. '.....ft............ ......... . ... ..........._.....................
.. �. St%..... -�f' � )� .
Name Street, City and ate
Vr
Relationship to Deceased..........5.!.5...:.................................................................................................................................................................._........
MedicalAttendant . -A........... :�G�.... ... .....................................................................................................................
Name Street, City and State
_ Z
c
Cause of Death ......... .� ,,1 .L....... �. ..1 .. _ - . .................................... ....... .. ..----•
.. .... .... ...
Name of Funeral Director
reet, ity a d State
d
Cremationon...................................................•--•--.................the------..................................Time of arrival
DLSPOSMON OF CREMATED RREN AINS
To be callea for ❑ Inter ❑ Ship ❑ Store ❑
Deliverto ...................................................•--.......................---....................._............-•-•----................
Name Addrm
Shipto ......................•----...•-•--•...............................---..............................._.......---•----•...-------•••-••••••..........................................................................................
Name Addrew
Ref. No........................_..
Interin "Oakwood" Lot No......................... Section.....................Owned by ..........................................................._........................._..............
Place in Crematory Niche No..........................for month............year............... Perpetuity ......................................................................_..
Place in "URN GARDEN". Location No................................................................Inscription on Marker
.......................................................................-----
......................................................................._.