Wood, Erin T0114N OF QUEEVBU9 Y
PINE YEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director L�,,IAE-701Y
Name k7 R IN iel-eD Case #
Date of Cremation
Time Cremation Started
Time Cremation Completed t '�/� �"/ '
Type of C o n t a i n t7 r ! /
Remarks :
Il 11
r
i btJN U� bUl=pNsgUtty
p I NE V I tW t:EhiE t EftY Ca -7�
t:NEMn t un I UM
Quaker Road, Uueontbury, New York 12804
Phone (519) CremAtoriUA 745-4477 or if no answer
Cemetery 745-4476
nUMU"tMTtUN tO CaEMnrE
The undersigned request 's And Authoriies Pine View Crematorium, in
accordA"ce with And subject tH itt nul#t And Rbgulations to
cremate the rOMAins of !
Erin Elizabeth Wood Fetsale --
(Name)
54 Adirond ck
(Street ) (City) (St Ate) (Zip Code )
who died on Ath -day ofgune 19
a
(Place) (Addtrl+ls )
Name and addr643 of hearogt living r-rlativ0 or "#mj of person
Authbriting creMAtibh !
Ted Wood Adir �ndaejt Rd.
(NAIee) (Addre9,)
Relatioh4hip to the deteAtod
NaM# of 1unerdl NoM
IMptinIrl"T! tho b!*t of my knowledge, the deceased has or
I r�pre3erit tha to
hA hit br her bbdys (Cire1@ Unr)
I tlrtify
that I ha+�b the full POW" And Authorization to arrange
for the crrMAtion of the r!►MAin3 And to dirlct th# disposition of
th@ ct-#MAt#d i-OMAihsi thAt Ahy 06""Al pO44644ions have either
beeh i-o0ovbd or May by dpktrbyEdi And agree to protect, defe,,d
and §ave harmless Pine View CroaAtorium from any And all claims
and doMandt for loss or dAM6904 Whith may be made Against them by
re`dsbn of or coh"@cted with th# ti-tMAtion of *aid remains as
directed, whether such tlaiiAg or d#mAhd4 Ar(! or Are not wholly
groundleS§, false or frAudul@nt.
x '7n
(WitnC►* > Mddreti)
(Signature of Relative or LlgAl Rep. and Address)
Signed on this dAtO . ( � �O`1 � r z, � � '
blsnuSIttUN OF unEMn>tEn ar:MntNs
I hereby direct Pine View Crematorium to dispose of the crpmatPri
remains as follows :
Mail to
Other arrangements - please specify :
If pulverization of cremate remains is requested, check here
PUL t C 1 ES, nut- =S nNU PEGl1Ln I I UNs
i. The crematorium will be open for cremations 5 days a woo�t
7 :00 A. M. - 3: 30 P. M. Monday-Friday. No Holidays or Sund,ay,% ,
arrangements can be made for Saturday. Prearrangements 1,,
telephone for acceptance of remains is necessary.
2. Pine View Crematorium is located on the grounds of the Pint,
View Cemetery; Quaker Road, Town of Oueensbury.
3. An authorization for cremation properly signed by the nearest
next of kin or other authorized person stating that they do
the power and authority to arrange for the cremation of tl'r
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 Piro
View Crematorium from any and ail claims and demands for loss nr
damages which may be made against them by reason of or contteC-tnd
with the cremation of said remains and/or disposition of Sabi
remains as directed, whether such claims or demands are, a .vr,r
not wholly groundlesst false or fraudulent. This authorizIt- I ,.,
in addition to a regular burial permit must accompany the
remains.
4. All remains mutt by encated in a casket or suitable alternate
tontainer. Caskets and tontAiners must be of combustible
Material . No styrafoam or plastic containers will be accepted.
5. Tfi# quottIa" relative to tardiac pacemakers must be anc%j—
on tho authorization to cremate form before the remains will f'r
accept ed.
6. Unless other- arrangement % 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 Recut-ding Fee : Adult 1175. 00
Children (age 13 months to 12 years ) t100. 00 Infants ( stillborn
to 12 months ) 460. 00