Hamilton, Beatrice M. jotIvi'l v llwnj urcv-
f iNE VIEW CEMETERY lod CREMATORIUM
QUAKER ROAD, Q,i 81 79U R YZ NEW YORK 12801
(518) 793-9777
Funeral Dirictor
Case No.916/1
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Dale of Cremation Q Q
I'inin Cremation Started
Time Cremation Completed
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DISPOSITION OF CREMATED REMAINS
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mail to
Other arrangement - please specify:
Will Call For
If pulverization of cremated remains is requested, check here
POLICIES, RULES AND REGULATIONS
I. 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 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
he 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 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
i
TOWN OF QUEENSBURY OZ
PINE VIEW CEMETERY /
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 798-4726 or if no answer Cemetery 793-9777
AUT11ORIZATION 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:
Beatrice 14ildred Hamilton Female
Name Sex
28 Prospect Street Fair Haven, Vermont 05743
Street City State Zip Code
who died on 20 day of October 1990
at Sager Nursing Home, Fair Haven, Vermont 05743
Place Address
Name and address of nearest living relative or name of person authorizing cremation:
William Hughes Castleton, Vermont 05735
Name Address
Relationship to the deceased Nephew
Name of the funeral home Durfee Funeral Home
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 sue claims or demands are, or are not, wholly groundless, false or fraudulent.
t �� %
Wi ess
119 . Main Street Si nature of Relative or Legal Rep.
Fair Haven, Vermont 05r43 P•�• Box 35
Castleton, Vermont 05735
Address
Address
Signed on this date
No.
STATE OF VERMONT
EXAMINER'S PERMIT TO CREMATE A DEAD HUAIAN BODY
Full name of decedent Beatrice Mildred Hamilton
Decedent's address 28 Prospect St. Fair Haven, Vermont _
Date of death October 20, 19_9Dplace of death Sager Nursing Home. Fair Haven. Vt,
Cause of death certified by Stephen Rosmus MD
Permission to cremate the body of This decedent at
Pine View Crematorium
Queensbury, New York
(Name and uddre��of Crematory)
has been requested by Douglas V. Xing, Durfee Funeral Home
(Funeral Direetor)
Vermont F..D. Fair Haven Vermont 05743
• 1�6 119 X. Main St,, ,
License No. (Addreoir of Fmid-rul Director)
Being sufficiently informed as to the causes and circumstances of the death of the above
described decedent, permission is hereby granted to cremate the ody as r
Date (Signed)
requested.
20 October 1990 C_ r"' , Examiner
Addre 54 Woodstock Ave.
5201 (L)18 VSA SEC.
Rutland, Vermont 05701