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Aikens, Larry N.M.N. jott/p, U bte6l23 LLNG PINE VIEW CEhICTERY and CREMATORIUM QIIAKFR ROAD, QUEEN$©UPY, NEW YORK 12801 (518) 798 4 726 (5I8) 793-9777 l Funeral lirictor ' Case No. Dale of Cremation '3 ,rime Cremation Started �* '1'i.me Creakition Completed _ .I y 1'e of Container �/ 1l 1 1 lI S ~ D15f'0 1f'1U'N OF CkLEN1/►.IE < RE51AINS I hereby direct Pine View Crematc;riuin to dispose: of 'he cremated remains as follows: Mail to Other arrangement - please specify: Return to Michael G. Angiolillo Funeral Home, Whitehall, N.Y. 12887 If pulverization of cremated remains is requested, check here xx POLICIES, RULES AND RE'GU1,A',70NS 1. The crematorium will be open for creinat4on6 clays a vvee. 7:00 A.-,,A. -- 3.30 P.M. Monday-Friday. No holidays or Sundays, arrangements can be ma-ae for Saturday. I'rearrangements 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 Rueensbury. 3. An authorization for cremation properly signed by the nearest next to 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. No styrafoarn or plastic containers will be accepted. 5. The question relative to cardiac pacemaker-- 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. There will be a $10.00 charge for this service. Cremation, Administration Costs and Recording :,ee: Adult $1110.00 Children (age 13 inonths to 12 years) $90.00 Infants (stillborn to 12 months) $50.00 ADDITIONAL, SER'ViCi: Storage of cremated remains ._ per month $2.fits r TOWN OF QUE'tNSBURY PINE VIEW CEMETERY / & CREMATORIUM Quaker Road, Rueensburv, New York 12804 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: Larry N.M.N. Aikens Male Name Sex Great Meadow Correctional Facility, P.O. Box 51, Fort Ann, N.Y. 12821 Street ~(City��—(StateT IZip Code) who died on 7th _ day of February 19 90 at Glens Falls Hospital, Glens Falls, N.Y. 12801 (PI ce AddressJ— Name and address of nearest living relative or name of person authorizing cremation: Arthur A. Leonardo P.O. Box 51, Fort Ann, N.Y. 12821 Name ----address Relationship to the deceased Superintendent- Great Meadow Correctional Facility Name of the funeral home Michael�G. Angiolillo Funeral Home IMPORTANT: I represent that to the best of my knowledge, the deceased has or has no acernaker 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 cremate1] 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 claim:; find dcinands for loss or dainages which may be made against them by reason of, or connecteri with the cremation of said remains as directed, whether such claims or den;ands are, or ure not, wholly groundless, false or fraudulent. d ' Witness —T— tSiKnnture of Relative or Legal Rep. 210 Broadway, Whitehall, N.Y. P.O. Box 51, Fort Ann, N.Y. 12821 Address 12887 _ � - ----— -- :lddrnss) Signed on this date Fubruary 9, 1990