Hoyer, Meta C. TO%N OF QUEEVBURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director M Lei TO
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Name � Case # �
Date of Cremation �� 2
Time Cremation Started
Time Cremation Completed R. `' f rr -
Type of Container (,� d )�o " �'Jl�� ��
Remarks :
NI Ai 14 d901 1yR-'Q /01-1
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TOWN OF UMtNSRURY
PINE VIEW CEMETERY
4
CREMATORIUM
Quaker Road, QueensbUry, New York 12804
Phone (518) Crematorium 745-4477 or if no answer
Cemetery 145-4476
AUTHORIZATION TO CREMATE
The undersigned request 's and authorizes Pine View Crematorium, in
accordance with and subject to itt Rules and Regulations to
cremate the remains of:
Kota Christina Hoyer Female
(Name) (Serf)
Fort Hudson Nursing Hove Fort Edward, NY 12828
(Street ) (City) (State) (Zip Code)
who died on 16th day of April 19 96
at tort Hudson Nursing: Home Upper Broadway Fort Rdyarrl- NY 12828
(Place) (Addre63)
Name and address of nearest living relativ# or name of person
Authorizing cremation:
Lillian Weiskotten 67 Oak Street Hudson Falls , NY
(Name) (Addres3)
Relationship to the deceased Daughter -
Name of Funeral Home-Carletan Funeral Home Inc
-
IMPORTANT:
�tf
ent that to the best of my knowledge, the deceased has or.
acemaker in his or her body: (Circle One)
1 certify that I have the full power and authorization to arrange
for the cremation of the remains and to direct the disposition of
the cr**Atod remains# that ahy personal possessions have either
been re0oved or may be dpstroyod, 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 connpctod with the tremAtion of laid remains as
directed, whether such claims or demands are or are not wholly
grou ss, f Ise or fraudulent.
/4 Carleton Funeral Home , Inc .
(Wi nos s) (Address)
(Si nature of Relative or Legal Rep. and Address)
Signed on this date : April 19 1996 -
DISPOSITION OF CREMAtED RF.MnINS
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
i. The crematorium will be open for cremations 5 days a week
7 :00 R. M. - 3: 30 P. M. Monday-Friday. No Holidays or Sundays,
arrangements can be made for Saturday. Prearrangements tlti'
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 hav;'
the power and authority to arrange for the cremation of tha
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 Pinp
View Crematorium from any and all claims and demands for loss of
damages which may be made against them by reason of or connect -f+
with the cremation of said remains and/or disposition of s.airt
remains as directed, whether such claims or demands are, or airy
not wholly groundless, false or fraudulent. This authorizat- i ,
in addition to a regular burial permit must accompany thr?
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 ans%,P, r •1
on tho authorization to cremate form before the remains will t,c
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 $20. 00
Charge for this service.
Cremation, Administration Costs and Recording Fee : Adult $ 175. 00
Children (age 13 months to 12 years ) $ 100. 00 Infants ( stillborn
to 12 months) 160. 00