Canale, Lucy 50tun O uee` i arY -
ritlE VIEW CEMETERY and CREMATORIUM U
QUAKER ROAD, QUEEN$QURY, NEW YORK 12801
(518) 798 4 726
(518) 193-9777
Funeral Dirictor ,geEJ��! 1
I1.lme /w ff51 N Case No. ��f,
Da Le of Cremation Az zle — 9/
'1'inM Cremation Started
Time Cremation Completed / 02/ /D )P,1 �
7}E of Container / .45 //•
1?crr�i r.k s 41 /V ®,/V
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DISPOSITION OF CREMATED REMAINS
I hereby direct Pine View Crematorium to dispose of the cremated
remains as follows :
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Ma i 1 t o iIZ i%a .4, t
Other arrangements - please specify :
If pulverization of cremate 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 of 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.
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 $155. 00
Children (age 13 months to 12 years) $90. 00 Infants (stillborn
to 12 months) $50. 00
TOWN OF QUEF.NssBURX
PIKE VIEW CEMETERY
A
CREMATORIUM
Quaker hoed, Queensbury, New York 12904
Phone (518) Crematorium 799-4726 or if no answer Cemetery 793--9777
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AUTHORMATION TO CREMATE
The U*ersigned requests and authorizes Pine view Crematorium, in accordance with and
subject to its Rules and Regulations to cremate the remains of.
(Name
1
Street City State Zip Code
i
who died on _day of ��c! •--1g —
Place Address
Name and address of nearest living relative or rt8me of person authorizing cremation_
ame Address
Relationship to the deceased
Name of the funeral home
IMPORTANT:
I represent that to the best of my knowledge, the deceased has o has n pacemaker in his
or her aody- (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, r are not, wholly gr ndle5s, false or fraudulent.
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Wi ness Riar,st .rn of R,pin*:.,.. .,r T
Address) Address
Signed pjn this date_
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TOTAL P.81_.