Haltermann, Delores M. 2'owN 4F QUEEVBUP,,.y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSDURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director_6) �-c o
Name Dqdnp.e"'7 l Al jf'1? 4bA4case #i
Date of Cremation 3 217 - q (p
Time Cremation Started (�Q �
Time Cremation Completed _ L A,
Type of Container �_i�p i �,� �'jG✓l( i i,¢1.2E�(?7 ` I 7 �"}'CJ a��j�l'
Remarks :
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TOWN OF OUEENSOURY
PINE VIEW CEMETERY
A
CREMATORIUM
(,luaker 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:
Delores Marguerite Haltermann Female
(Name ) (Sex)
Box 89, Haltermann Road Granville, MY
(Street ) (City) (State ) ( Zip Code )
who died on 25th d a y of Harms 19 96__
alGlens Falls Hospital 100 Park Street m pns Follm, Hi 12801
(Place) (Address )
Flame and address of nearest living relative or nam•e, of person
authorizing cremation :
Daniel J. Haltermann Sr. Box 89 Halterman Rd , Granville , NY _
(Name) (Address)
Relationship to the deceased Husband
Name of Funeral H o m Carleton FLnprgl tt�,�e Tn.+
IMPORTANT:
I resent that to the best of my knowledge, the deceased has or
ias 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
reasor► of or connected with the cremation of said remains as
directed, whFther such claims or demands are or are not wholly
gr rid ss, se or raudulent.
Carleton Funeral Home
(Witness ) (Address)
" >
- Granville NY
(Signature of Relative or Legal Rep. and Address)
Signed on this date : 3/26/96
1
DISPUSITIUN UF= CREMATED RFMnINS
I hereby direct Pine View Crematorium to dispose of the cremataci
remains as follows :
Ma i l to --------------------- - ----— --- --
Other arrangements please specify '
verization of cremate remains is requested, check here V
If pul —
POLICIES, RULES AND REGULATIUNS
1 . The crematorium will be open for cremations 5 days a wept(
7 :00 A. M. - 3: 30 P. M. Monday-Friday. No F-lo l idays or Sundays,
arrangements can be made for SAturday. Prearrangements by
telephunIe for acceptance of remains is necessary.
F_. Pine View Crematorium is located on the grounds of the t�
View Cemetery, Quaker Road, Town of Queensbury.
3. nor authorization for cremation properly signed by the nearest
next of 1( 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 te
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 Creoiaturtum from any and all claims and demands for loss of
damages l,ji? tcl-r 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 answer-rri
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 cremattor'
to the funeral home handling the service. There will be a t20. 00
charge For this service.
Ct-Pmation, Gldmirvistr-atton Costs and Recording Fee : Adult $ 175. 100,
Children (age 13 months to 12 years ) $ 100. 00 Infants ( stillborn
to 12 munths ) $60. 00