Eager, Carl T- O- (T,VN OF QUEEN,5, BURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD. QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director / F,'-1 /19A V 22y!2 /3'/ )r�f /Q
Name o 1 ` L �/1(3 J�d Case #
Date of Cremation ✓ _ Z U Ct
Time Cremation Started t
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Time Cremation Completed
Type of Container
Remarks :
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TOWN OF QUEENSBURY f I
PINE VIEW CEMETERY
a
CREMATORIUM
Quaker 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:
Carl W. Eager M
(Name) (Sex)
RR 1, Box 47, Nortr, ,:reek,NY 12853
(Street ) (City) (State) (Zip Code )
who died on 17th day of March 19 96
at GFH, Glens Falls,NY
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation :
Lesa M. Winter (Niece) RR 1, Box 47, North Creek,NY 12853
(Name) (Address)
Relationship to the deceased Niece
Name of Funeral Home Adirondack Cremation Associates,Warrensburg,NY
IMPORTANT:
I represent that to the best of my knowledge, the deceasedXXX€10X0X
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 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
dire ted, whether such claims or demands are or are not wholly
gro Bless, false or fraudulent .
Warrensburg,NY
(W ' tness) (Address)
--a7h'�&
Same as above
(Signature of Relative or Legal Rep. and Address)
Signed on this date : 3-18-96
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DISPOSITION OF CREMATED REMAINS
I hereby direct Pine View Crematorium to dispose of the cremated
remains as follows :
Mail to
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 weeti
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 stinting that they do have
the power and authority to arrange for the cremation of tre
remains and to direct the disposition of the cremated remains,
that any personal possessions have either been removed or destroyed and agree may be
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
remains. must accompany tre
4. All remains must be encased in a casket
container, or suitable alternate
Caskets and containers must be of combustiole
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 oe
accepted,
6. Unless other arrangements are made the cremated remains
be mailed via Registered U. S.to the Mail within three days of crematio�
funeral home handling the service. There will be a s2o. 00
charge for this service.
Cremation, Administration Costs and Recording Fee : Adult s175. ,,-
Children (age 13 months to 12 years ) s100. 00 i : loo,
to 12 months ) s60. 00 Infants ( st