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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 f Time Cremation Completed / t- S(0 /g/ I Type of Container !/ Remarks M /J` /t �� /Y,�/1 ® /Y /` ju e ��� ' � oZe4211n 1 �j 41 zlY® Coe k aoo/y 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.