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Farrington, Stephen G. jott/pt U LLee`2:S I�GN(.f riNE VIEW CEMCTERY and CREMATORIUM �U QUAKER ROAD. Qa18)7O [Y. NEW YORK 12801 (518) 793-9777 Q Funeral Dirictor n c L �/ ��,P�`N�'To/� Case No. UaLe of Cremation 'I'inip Cremation Started '1'i.tile Crenot ion coinpl�eteed,� 1�1 of Ctrntainer r�cnor.ks 1 f © A/ DISPOSITION OF CREMATED REMAINS I hereby direct Pine View Crematorium to dispose of the cremated remains as follows: Mail to Other arrangement - please specify: Funer`il Director to pick up same day . I ulverization of cremated remains is requested, check here f' POLICIES, RULES AND REGULATIONS .� x••s: 5 1.: The:c` ". tQrium will be open for cremations 5 days a week 7:00 A.M. - 3:30 P.M. Monday-Friday. No II'oh�ar ��,y s, arrangements can be made for Saturday. Prearrangements by telephone for accept=c'e'a 'e' iajps is necessary. 2. Pine View •Crematoria Igcated on the grounds of the Pine View Cemetery, Quaker Road, Towit•of Rueensbur • 3•,': e authorization for crematio ,signed by the nearest next to kin or other authorized pe1 ¢n sating that they do hav t and authority to arrange for the cremation of the r�rtt�s and to direct the o ' of the cremated remains, that any personal possessions ' ekdti*.been removed or estroyed and agree to protect, defend and save harmless � e Wti v�-`-Qrematorium from.a d all claims and demands for loss of damages which may aY be;rrrade'aa4t�st them by reas , or connected with the cremation of said remains and/or disp6j t'i said remains a cted, whether such claims or demands are, or are not wholly groundle `t' Ise or fraudul This authorization in addition to a regular burial permit must accompany teeremains 4. All remains must ased in a casket or suitable alternate container. Caskets and containers must be' ombustible material. No styrafoam or plastic containers will be accepted. 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. There will be a $10.00 charge for this service. Cremation, Administration Costs and Recording Fee: Adult $140.00 Children (age 13 months to 12 years) $90.00 Infants (stillborn to 12 months) $50.00 ADDITIONAL SERVICE Storage of cremated remains - per month $2.00 TOWN OF QUEENSBURY PINE VIEW CEMETERY CREMATORIUM Quaker Road, Queensbury, New York 12804 Phone (518) Crematorium 798-4726 or if no answer Cemetery 793-9777 AUTHORIZATION TO CREMAE� The undersigned requests and authorizes Pine View Crematorium, in accordance with and subject to its Rules and Regulations to cremate the remains of: Stephen G. Farrington Male Name Sex • Old Military Road Lake Placid, N Y 12946 Street City State Zip Code who died on 12th day of August 19*90 ' try at Old Military Road Lake Placid, N. Y . (Place) Address Name and address of nearest living relative or name of p iag cremation: ilitrs . Frances M . Farrington Old M e Placid Name Address Relationship to the deceased Wife AE . Ink, J'nt. 27 Saranac &Va. Name of the funeral home Z&U Piacfd. N.Y. 22944 IMPORTANT: I represent that to the best of my knowledge, the deceased has or 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 Signature of Relative or Legal p. 27 Saranac Ave . Old Military Road, Lake Placid (Address Lake Placid, NY Address Signed on this date 8/13/90