Boudreau, Mary TORN OF QUEEVBU9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSHURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director_[IiL6A1S('Q,Ck'— /`/l�
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Name /� DL°l� ,� Case #
Date of Cremation
Time Cremation Started // 1t3 9 lgtA4
Time Cremation Completed. [d® PP M% -
Type of Container
Remarks :
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TOWN OF QUEENSBURY
PINE VIEW CEMETERY = �
i
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phon( (513) Crematorium 745-4477 or if no answer
Cemetery 745-4476
AUTHORIZATION TO CREMATE
The undersigred requests and authorizes Pine View Crematorium , ; n
accordance pith and subject to its Rules and Regulations to
cremate the remains' of:
Mary Ellen Boudreau F
(Name ) (Sex)
Box 158, Rt.28, Warrensburg NY 12885
(Street ; (City ) (State) ( Zip Code )
who died on _ 7th day of May 19 96
at ATCNH, North Creek,NY
(Place) (Address)
Name and address of nearest living relative or name of perscn
authorizing cremation :
Elizabeth Schuster, 13 iames St., Warrensburca,NY 12885
(Name ) (Address)
Relationship to the deceased daughter
Name of F u n e r al H o m e Alexander-Baker FH,Warrensburg,NY
IMPORTANT:
I represent -rat to the best of my knowledge, the deceased)
has no pacem, ,cer in his or her body. (Circle One )
I certify th. t I nave 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 removec or may be destroyed, and agree to protect , de =enc
and save harrless Pine View Crematorium from any and all claims
and demands for loss or damages which may be made against them oy
reason ,' of or connected with the cremation of said remains as
directed, wtather such claims or demands are or are not wnoiiy
group ess, else or fraudulent .
Warrensburg,NY
(Witness ' (Address)
V?t'4Cj-Wck )41-" St-� Same as above
(Si atu •e of Relative or Legal Rep. and Address )
Signed on th i , date ; 5-7-96
DISPOSITION OF CREMATED REMAINS
I hereby direct Pine View Crematorium to dispose of the
remains as follows : c emate
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 wee
7 :00 A. M. — 3: 30 P. M.
arrangements can Monday—Friday. No Holidays or Sundays .be made for Saturday. Prearrangements
telephone for acceptance of remains is necessary. V '
2. Pine View Crematorium is located on the r
View Cemetery, Quaker Road, Town of Queensbury• ounds of the �) ; ne
3. An author-ization for cremation properly signed by the nearest
next of kin or other authorized person statin
the power and authority g that they do have
remains and to direct the tdisrositionfof or the cremation or t �,p
that any personal p the cremated remains ,
Possessions have either been removed or may ^e
destroyed and agree to protect
V1eW Crematorium from + defend and save harmless p : ^, e
any and all claims and demands for loss 0 ,7
damages which may be made against them by reason
with the cremation of or connectec
of said remains and/or
remains as directed, whether disposition of
not "holly such claims or sate
Y groundless, false or fraudulent . demands are, za are
in addition This author ; zat :
to a regular burial permit
remains. must accompany t c
4• All remains must be encased in a casket or suitable alternate
container. Caskets and containers must
material . Nc styrafoam or plastic containers beobe combust ; c : e
ll
ptee.
5. The question relative to cardiac
on the authorization to Pacemakers must be an5we_ec
accepted. cremate form before the remains 6., ; 11
6. Unless ether arrangements are made the
be mailed via Registered U. S. cremated remai s
to the funeral homeMail within three days of
handli cremac ,
9 o the handling the service. There will be a
charge for s service.
Cremation, Ac , lnistration Costs and Recordin F
Children (ag ' 13 months to 12 9 ee : Adult
to 12 months ) $60. 00 Years ) f100. 00 Infants ( st i ^``-