Owen, Mabel own o ueew ltNv
PINE VIEW CEMETERY and CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12801
(518) 798-4726
(518) 793-9777 ,!//
Funeral Dirictor 9611r *1<4
Name 1/!��' !/ij�,tJ�� h ltJ /� Case No. 711�6 02 FA 5
Date of Cremation
Time Cremation Started / �j 3, / /yl f
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Time Cremation Completed / t- S(0 /g/ I
Type of Container !/
Remarks M /J` /t �� /Y,�/1 ® /Y /`
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DISPOSITION OF CREMATED REMAINS
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mail to Funeral Home
Other arrangement - please specify:
If pulverization of cremated remains is requested, check here XXX
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.
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.
Cremation, Administration Costs and Recording Fee:
Adult $125.00
Children(age 13 months to 12 years) 80.00
Infants(stillborn to 12 months) 45.00
Shipping container, carton and packing fee for shipping and registered priority mail with return receipt
included in the above prices.
ADDITIONAL SERVICE
Storage of cremated remains-per month $ 2.00
TOWN OF QUEENSBURY
PINE VIEW CEMETERY
8
CREMATORIUM
Quaker Road, Queensbury, New York 12801
Phone (518) Crematorium 798-4726 or if no answer Cemetery 793-9777
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:
_ Mabel Owen Female
(Name) (Sex)
Route 9 Saratoga Springs, NY 12866
(Street) (City) (State) (Zip Code)
who died on December the 26 day of 1988
at Mendham, New Jersey
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremation:
Mrs. Brenda Lee 744 Saratoga Road Gansevoort, NY 12831
(Name) (Address)
Relationship to the deceased Daughter
Name of funeral home William J. Burke & Sons Funeral Home
IMPORTANT: XX
I represent that to the best of my knowledge,the deceased WXXX X 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
groundless, false or fraudulent;
(Witness) V (Signature of Relative or Legal Rep.)
William J. Burke & Sons FH
628 North Broadway SSNY 12866 above
(Address) (Address)
December 26, 1988
Signed on this date
STATE OF NEW JERSEY
BURIAL, CREMATION, OR
TRANSIT PERMIT
State law requires that no person shall cremate a dead human
body unless at least 24 hours have elapsed from time of death
listed on death record.
(NAME OF DECEASED{
IDATE OF BURIAL OR ENTOMBMENT)
at S,5 C1 PM
IDATE AND TIME OF CREMATION)
(SIGNATURE OF SUPERINTENDENT OF CEMETERY OR CREMATORIUM)
This permit must be delivered to the superintendent of the
cemetery or crematorium where burial,entombment,or cremation
is to take place,who should fill in the spaces above and forward it
within ten days to the registrar of vital statistics,of the district in
which the cemetery or crematorium is located.
When burial takes places in a cemetery which has no person in
charge,the spaces above should be filled in by the funeral director,
who should write"no person in charge"on the line for signature of
superintendent of cemetery and file the permit with the registrar of
vital statistics,of the district in which the cemetery is located.The
law requires that this be done within ten days after burial.