Wynne, Irving J. jotIvi't U �tee�2:s �tNl�
rmE VIEW CENICTERY anct CREMATORIUM
Ql1AKrR ROAD. QU18)79� Y. NEW YORK 12801
i
(5I8) 793-9777
Funeral Dirictor /��/�� /
Case No. /
11.�me �r I
UaLe of Cremation
,I*inx, Cremation Started
t '
'1'i.me Cremation Completed r
of Ccmtainer
I hereby direct Pine View to dispose of the reniaiii.,- aY follows:
Mail to
Other arrangement - please specify:
Return to Michael G. Angiolillo Funeral Home
If pulverization of cremated renrains is requested, I,er(,X
POLICIES, RULES ANO RI-`.CUi.ATW'.N-S
i. The crem6toriun) will Oe open for cl-eIIIIIII01"', a Oby,4 b Wece 7:k)0 A.IM. -- 11:A P—DO, Monday-Friday.
No Holidays or Sundays, arvarigeoients car, be viadc !'I)i S):tu,,!I;,y. v'r-Nirrangements by telephone
for acceptance of remains is ne-_,.;ssz.!-y.
Pine View Cremalovium is lochu n ci lh< ':-t i:iiit_ V Cemelery. Quaker
it—v
Road, Town of Queensbury.
3. An authorization for cremation Vrope,%, ac, W the next tc, Kin _)r other tiathoriwcd
person stating that they do have the power nad auLh,riLy to arrange for the cremation of
the remains acid to direct the disposition of the t-re.rnateri remaimi, that any personal possessions
have either been removed or mat, b(.- de,,troyedl aild ap', t?u, io pro'LCtA, defend and SaVe harmless
Pine View Crematorium from any and all claims an-d (jejUltioid's for loss of dal,111ges which may
be made against them by reason of, or connected with t)ae ..xerriation of said remains and/or
disposition of said remains as direcied, whether stcli cl&inis or demands are, or Tire not wholly
groundless, false or 'fraudulent. This authorizati-m ir. addition to a regular ourial permit must
accompany the remains.
4. All remains must be encased in a (-asKet or ;:.-iiiible altei,nate containcr. fl-'askeLs and
containers must be of combustible material. No styrafoaiii or plustie containers will be accepted.
5. The question -relative to cardiac pacemakers nosi be jA� n-,were,' on the authorization to
cremate form before the remains will be accepted.
(;. Unless other arrangement, are iii aide, the crcn,i,,U�O %V,ii (,,c moiled via Registered
U.S. Mail within three days of cremation !.-.) the fiaterai lioo& handling the service. There
will be a $10.00 charge for this service.
Cremation, Administration C"osts and F%2e,
A(I'Ljlt $1 oi)
Children (age 13 111011LIV -_u
Infants to 12
Storage of cremated
TOWN OF QUE.ENSBURY l
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 798-4726 or if no answer Cemetery 793-9777
AUT110RIZATION TO CREMATE
The undersigned requests and authorizes Pine View Crematorium, in accordance with and
subject to its Rules and Regulations to cremate the remains of:
IRVING J. WYNNE
Name - - - MALE
` Sex)
@$ Gilmore Street Whitehall
Street City Mute d-'Lip Code�—
who died on 5th day of June 19
90
at Rutland Re ional Medical Cen r
Place Address R"tlanrL, v+
Name and address of nearest living relative or name of person au[horizi[;g cremation:
Patricia Wynne 831 Hampshire St. , San Francisco, Ca. 94110
Name
Relationship to the deceased Daughter
Name of the funeral home Michael G. Angiolillo Funeral Home
IMPORTANT:
I represent that to the best of m;; knowledge, the deceased has or has no pacemaker in his
or her body. (CIRCLE ONE)
I certify that I have the full power a;[(i f)ulhoriz ition t ari;ine 1`or tic 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 , not, wholly groundless, false or fraudulent.
Witness
Signature c L Relative Legal Rep.
210 Broadway, Whitehall N,y, 831 Hampshire St.
Address) 12887 — dd _�_ San Francisco, Ca. 94110
��lressj
Signed on this date June 6 , 1990