Loading...
Hobbs, Dorothy N. 50uln v ueeni ur . PINE VIEW CEMETERY and CREMATORIUM QLJAKrR ROAD, QUEEN$QURY, NEW YORK 12801 (518) 798 4 726 (518) 793-9777 Funeral Dirictor � r II,,ulA dM5, DO- ® d Case No. � 9 Da Le of Cremation &—/ — Tim Cremation Started �� � //fl r Time Cremation Completed , d /0 1�71m r 'I}p- of ContnineC rl"/79,Qd-&D i DISP08111ON OF CREMATED REMAINS I hereby direct Pine View Crematorium to dispose of the cremated remains as follows: Mail to Fletcher Tiirkar Rt 11 , Box 20 , Burke , NY 12917 (let Carletons know the day Other arrangement - please specify: cremains are mailed 747-4243) If pulverization of cremated remains is requested, ere uested check h ✓P q 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. :1. 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 Dine 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. 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 if f 65•0e Children (age 13 months to 12 years) $10.00 ! Infants (stillborn to 12 months) $50.00 TOWN OF QUEENSBURY 7 PINE VIEW CEMETERY & CREMATORIUM Quaker Road, Queensbury, New York 12804 Phone (518) Crematorium 798-4726 or if no answer Cemetery 793-9777 AUTIIORIZA71ON TO CREMATE ,he undersigned requests and authorizes Pine View Crematorium, in accordance with and subject to its Rules and Regulations to cremate the remains of: Name Sex f emaLe S ringSt Falls NY 12801 Street City State Zip Code who died on 5th day of November 19 91 at 16 S rin St . , Glens Falls , NY 12801 Place Address —— Name and address of nearest living relative or name of person authorizing cremation: Name Hnh 16 S rin St Glens Falls NY 12801 Address Relationship to the deceased Name of the funeral home . n unera ome nc 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 V, w Crematorium, from any and all claims and demands for loss or damages which may b ade against them by reason of, or connected with the cremation of said remains as dir t d,.whether such claims or demands are, or are not, wholly groundless, false or fraudulent. tness 68 Main St nature o Regal Rep. Hudson Falls , NY 12839 16 pring Stelat ve or L Address Glens Falls , NY 12801 Address Signed on this date