Lloyd, Bertram T0114N OF QUEEVBU-'�Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director c�RRte -To-kl 1f
Name G eA-V R e)�1 � - . 610 4C a s e # �'�r2
Date of Cremation 2 G2
Time Cremation Started r)
Time Cremation Completed 21
Type of Container CQ &0 1 `i�L'�►`i
Remarks:
11141,1V Oil
TOWN OF OUEENSPURY
PINE VIEW CEMETERY
A
CREMATORIUM
Ouaker Road, Queensbury, New York 12804
Phone (518) Crematorium 745-4477 or if no answer
Cemetery 745-4476
AUTHORIZATION 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 :
Bertram Linus. Lloyd Male
^(Name,-- (sex)
P.O. Box 96, Diamond Pt. Rd. Lake George, NY 12824 -
�(St rr:et ) (City) (State) ( Zip Code )
who died on 4th day of Fahr>»ry 19_96
at Diamond Point Road, Diamond 'Point , NY
(Place) (Address )
Name and address of nearest living relative or name^ of person
authorizing cremation :
Mrs. Frances Lloyd P.O. Sox 46, Diamond Pt Rd.
(Name ) (Address)
Relationship to the deceased Wife
Name of r-uneral Hom@arleton Funeral Homo Inc,
IMPURIANT:
I repress ' to the best of nay knowledge, the deceased has or
Ila nu pacem 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 such claims or demands are or are not wholly
g2'c')"'Ieen
n dless, f/a se.t.�or fraudulent.
S . Nikas 68 Main St . , Hudson Fall
s , NY
(Witness ) (Address)
(Signature of Relative r Legal Rep. and Address)
Signed on this date : February 6 , 1996
DISPOSITION OF CREMATED RFMOINS
I hereby direct Pine View Crematorium to dispose of the cremated
remains as follows :
Mail to ----------- -- --- ---- —
Other arrangements - please /
If pulverization of cremate remains is requested, check here"
POL.I C I ES, RULES AND REGULATIONS
1 . Hie crefaator- ium trill he 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 P,
View Cemetery, ouaker Road, Town of Uueensbury.
3. An authorization for cremation properly signed by the nearest
ne><t of L< in 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 airy 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.
h. All remains must be encased in a casket or suitable alternate
container. CaskPLs and container-, must be of combustible
material. No styrafoam or plastic containers will be accepted.
5. The question relative to cardiac_ pacemakers must be answer-cr+
on the authorization to cremate form before the remains will tip
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 t20. 00
charge for this service.
Cremation, Administration Costs and Recording Fee : Adult f175. 100
Children (age 13 months to 12 years ) $ 100. 00 Infants ( stillborn
to 12 months ) $60. 00