Loading...
Taylor, Robert C. jou/n U �cee�2s l�Nl ritlE VIEW CEMCTERY and CREMATORIUM QIIAKF.R ROAD. Q;i8)713 Y, NEW YORK 12801 (518) 79:3-9777 Funeral Dirictor M '� /1 // Case No. � � /�Q UALe of Cremation -1-inw, CretttaL iotl Started � �M 'rime Creak3Lion Completed 7�1e of container � 71 j • � /1/�' tom' ©n� �/' -3D � ! _ t�crtt,•�r.�s / � -� Al ©� 4J/ DISPOSITION OF CREMATED REMAINS I hereby direct Pine View Crematorium to dispose of the cremated r mains as follows: Mailto Roberts - Aubin Funeral Home, P.O. Box 18r, Poultney, Vt . 05764 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 clays 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 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. R. 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 r155.00 Children (age 13 months to 12 years) $00.00 Infants (stillborn to 12 months) $50.00 TOWN OF RUEENSBURY PINE VIEW CEMETERY do CREMATORIUM Quaker Road, Rueensbury, New York 12804 Phone (518) Crematorium 798-4726 or if no answer Cemetery 793-9777 AUTIiORIZATION 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: Robert C . Taylor Male Name Sex 11 Allen Terrace , Poultney, Vt . 05764 Street Cit y State Z!"- Ccds who died on February 20 , 1991 91 day of 19 at Rutland Regional Medical Center, Allen St . , Rutland , Vt . 05701 Place Address —— Name and address of nearest living relative or name of person authorizing cremation: Mr . T. Blair Traverse 11 Allen Terrace , Poultney, Vt . N a me Address Relationship to the deceased Guardian Name of the funeral home Roberts - Aubin Funeral Home IMPORTANT: I represent that to the best of my knowledge, the deceased has or has no paGemnl4er it hea 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 Relat ve or Legal Rep. Address 11 Allen Terrace , Poultney, Vt . 05764 Address Signed on this date