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Bedell, R. Harold own o ueenj ark PINE VIEW CEMETERY and CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12801 (518) 798.4726 (518) 793-9777 Funeral Dirictor/X/,T , Name �� Jy/9Qh ,� �� - Case No. * Date of Cremation Z "�y 9 Time Cremation Started 7 , Time Cremation Completed 9 Icl0 //r i i Type of Container c/�/�,b,�l9/P� SST�' S-cam" ®/� z2ai Remarks /�&tit/ ,�f�fj��iEi� ©/1� /ON `�°"�S�7 i/✓�i //I NO C oo ,< co 4) /� I,the undersigned,the next of kin of ......R Har old B e de 11 deceased,do hereby 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 cremated remains, that any personal possessions have either been removed or may be destroyed and hereby agree to protect,defend and save harmless the Troy Cemetery Association and/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. It is requested that the following disposition be made of the cremains: (Check One) ( XX)Shipto* M. B Clark, Inc . , 27 Saranac Ave . , Lake Placid, N. Y. 12946 The undersigned hereby authorizes the Crematory to deliver the cremains Via REGISTERED U.S. MAIL and agrees to assume all liability for any damages that may arise from any cause growing out of said delivery and to indemnify and hold harmless the Gardner Earl Memorial Chapel and Crematorium and/or the Troy Cemetery Association from any and all claims related to said shipment. The undersigned also agrees to pay the charge for such delivery. ( ) To be called for ( ) Inter in "Oakwood" Lot No. Section Owned by ( ) Place in "URN GARDEN" Location No. Inscription ( )Place in Crematory Niche No. for month(s) Year(s) Perpetuity ( ) Dispose of the Cremains , WITNESS: 1 .cR,. ��4-rs. . f t� .. ktX r . .. Signed:*. Address: A3?.9.SP.,.AJ,tQn.$.t... . . . ... ..I. .. Address: .46. Foxe.st..St.. .. . .. . . . .. . . . .. . . .. .. City:En lewood, . . . . .. .State Colorado . : City: LAlkp. ,Placid, ..State.NY.. . .. .Zipl?.9.�6. 80111� ... .. . .. . . ... .. .. . . ... .. . .. ... ... .. . .. . . . .... .. .. . . . .. ... ... . . .. . . .. . . . .. .. .. . .. . . . .. . . . . . . . . . .. . . . .. .. . .. . . Cremains received by Date Address: Prices Effective March 1988 CREMATION,ADMINISTRATION COSTS AND RECORDING FEE adult$130.00 Children (Age 13 months to 12 years) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90.00 Infants (Stillborn to 12 months) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50.00 Additional Services Temporary Cremains Box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Carton & Packing Fee for Shipping . . . . . . . . . . . . . . . . . . . . . . . . . . . . Included above Registered Priority Mail with return receipt . . . . . . . . . . . . . . . . . . . . . Cremation Case . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35.00 Storage of cremated remains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . per month 2.00 Perpetual Memorial Niches for Cremated Remains. . . . . . . . . . . . . . . . . . . . . . . . 400.00 ReceivingRoom. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 850.00 UrnGarden . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 975.00 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 operated by TROY CEMETERY ASSOCIATION (The �lJl IC°Qll]t��IC° eIC>11 orial �hapel �.]Cl J Crematorium operated by TROY CEMETERY ASSOOg�T_LO�_---&&GAKNV0- " --- �, ,�,,� PHONE 272-7520 I�REMATORY—l)AKWOOD AVE. TROY, N. I. 1Lli7D AREA CODE 518 ��— OFFICE—CCR.OR. IOIST ST. AND NTH AVE. 41 �/ ) -7e:F/f/ AUTHORIZATION TO CREMATE *25Z-7�3 No...................................................... 1988 Date........De.g.�...3.0.,<....19..88.............................. Nameof Deceased ...............R...... ._...................._.........................................................Sex.._........Mal. ........................ Residence .... 6 Forest Street Lake Placid NY .......s....................e........... ------ ----..............a. .i. ........................................._.............................................. City or Town State Single................................. Married....xx....................... Widow......................---------- Widower.............................. Divorced......................_.. Age—................................... . .... Years.......................................... Months.......................................... Days Place of Birth .............Saranac .Lake......NY..................................................................Date of Death...V3.1A....................— ............. .. Place of Death ..........._-........General Hospital of Saranac Lake , NY Street, City and State Name and full address of nearest living relative or name of person Authorizing Cremation ................ rs.......Gx?a.0e...8.e all.................4.6...Far-eat ,....NY............................................................-... Name I Street, City and State Relationship to Deceased.........................Wife................................... Medical Attendant Richard Handlers .MD, Gen. Hosp . .of Saranac Lake, _NY ---...... Name Street, City and State Cause of Death ...................Respiratory Arrest ............................................................................................................................................. Name of Funeral Director .............M...�....Qlavk s....ln.Q.,.,_..2.7.....�ax:axmc..A.ve.. Street, City and State Cremationon..........................................................................the........................................Time of arrival ..........._............................................... The Gardner Earl Memorial Chapel and Crematorium and/or the Troy Cemetery Association is not responsible for errors from phone orders. Remains will not be accepted for Cremation unless delivered in a combustible casket.* (*Corrugated cremation cases must have bottom board capable of supporting 350 pounds) The association reserves the right to refuse cremation when the remains are in a casket mad: of fiber glass, plastic, metal or other incombustible material; OR any incombustible material or substances placed within the casket that would be inj:Irious or damaging to the cremation chamber or the operator thereof.The funeral director in charge of the remains will be held responsible for any damages caused by disregarding the above restrictions. Hours are from 9:00 a.m. to 4:30 p.m. Monday through Friday, Saturdays until 12. No cremations will be performed on Sunday or Holidays, however remains may be received on these days by special arrangement without additional charge. SERVICES AVAILABLE IN GARDNER EARL MEMORIAL CHAPEL BY APPOINTMENT AND WITHOUT CHARGE NOTICE "Some heart pacemakers can be dangerous when placed in a cremation chamber.If the pacemaker is not removed,the family shall be responsible for any damage resulting and the crematory will not be responsible or accept any liability under those circumstances.