Stedman, Beatrice TURN OF QUEEVBURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSHURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director Nl e." IZ
Name Ste2MA N Case #
Date of Cremation
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Time Cremat i on St art ed
Time Crematioq Completed
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TOWN OF t1UEENSBURY
PINE VIEW CEMETERY
a
CREMATORIUM
Quaker Road, 0ueensbury, 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!
BEATRICE M. STEDMAN FEMALE
(Name) (Sex)
75 4TH STREET, GLENS FALLS , NY 12801
(Street ) (City) (State) (Zip Code)
who died on 19TH day of APRIL 19 96
at 75 4TH STREET GLENS FALLS NY
(Place) (Addrls!)
Name and address of nearest living relative or name of person
Authorizing cremation!
STEPEHN STEDMAN, 88 QUEENSBURY AVE. , QUEENSBURY NY 12804
(NAM0 (Address)
Relationship to the deceased SON
NaMe of Funeral Home M.B.KILMER FUNERAL HOME
IMPORTANT:
1 represent that to the best of my knowledge, the deceased has or
has no paceMaker in hie 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 crrMated t-#MAins, that any personal possessions have either
been removed Or may be destroyedi 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 dtoAndt are or are not wholly
groundless, false or fraudulent.
Witness) (Address)
(Si nature of Relative or Legal Rep. and Address)
Signed on this date : 4/19/96
bISPOSITION OF CREMATED Rl=.MAINS
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 S days a wpei<
7:00 A. M. - 3:30 P. M. Monday-Friday. No Holidays or Sunday. ,
arrangements can be made for Saturday. Prearrangements F",'
telephone for acceptance of remains is necessary.
2. Pine View Crematorium is located on the grounds of the Pinp
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 thr,
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 Pirip
View Crematorium from any and all claims and demands for loss nf
damages which may be made against them by reason of or connect -ri
with the cremation of said remains and/or disposition of satri
remains as directed, whether such claims or demands are, or arp
not wholly groundless, false or fraudulent. This authorizal- r
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. Tho question relative to cardiac pacemakers must be ansv-,; r ,r
on the authorization to cremate form before the remains will bay
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 t175. 00
Children (age 13 months to le years ) $ 100. 00 Infants ( stillborn
to 12 months ) $60. 00