Martin, James jott/p, U �Lee`2:S l,GNG
rmE VIEW CEMCTERY and CREMATORIUM
QUAKER (QUAD. QU1E,798URY. NEW YORK 12801
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(518) 793-9777
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STATE OF NEW YORK DEPT. OF CORRECTIONAL SERVICES
j GREAT MEADOW CORRECTIONAL FACILITY
COMSTOCK, NEW YORK 12821-0051
THOMAS A COUGHLIN.III TELEPHONE 518 639-5516 A LEONARDO
Superintendent
Commissioner
January 15, 1991
Barton-McDermott Funeral Home, Inc.
Pine Street
Chestertown, NY 12817
Attn: James McDermott
Dear Mr. McDermott:
On January 12, 1991 , inmate James Martin-86A7727 died at Glens
Falls Hospital.
Per phone call with Diane DuFour today, you have received the bid
for creamation of above inmate.
Our facility is giving permision for Barton-McDermott Funeral Home
for Creamation of this inmate at Pine View Creamatoryfor January 15, 1991 .
Respectfully Submitted,
Colleen Hooper, D.S.A.
cc: Diane DuFour
File
DISPOSITION OF CREMATED REMAINS
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mail to
Other arrangement - please specify:
If pulverization of cremated remains is requested, check here
POLICIES, RULES AND REGULATIONS
1. 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
Hine 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 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 $14U.00
Children (age 13 months to 12 years) -:00
Infants (stillborn to 12 months) $50.00
ADDITIONAL SERVICE
Storage of cremated remains - per month $2.00
TOWN OF RUE NS13URY �
PINE VIEW CEI#E'I(ERY
& j t
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 798-4726 or if no answer Cemetery 793-9777
AUTHORIZATION TO CREMATE
'rhe undersigned requests and authorizes Pine View Crematorium, in accordance with and
subject to its Rules and Regulations to cremate the remains of:
Name Sex
c 0f�I`'c�� // ,/lam
St re et ' S r UG K
City tate Zip Code
who died on ��i dayof
4h Jcr•' 19�
at
Place
Address ——
Name and address of nearest living relative or name of person authorizing cremation:
L�0lQGZ' C'C� bpi G..
Name Address
Relationship to the deceased
Name of the funeral home L,; v //
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, defe_�� and save harmless
Pine View Crematorium, from any and all claims and demands for los -or da:'nages which
may be made against them by reason of, or connected with the cr ation of said remains
as directed, whether such claims or demands are, or are not, W-. ly groundless, false or fraudulent.
Witness Signa re f Relative or Legal Rep.
fTE'� U w hAZ
Address �/ Address
Signed on this date /�/