Norton, Floyd L. zoUN OF QUEEVBURY
PINE !-?EW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
�i '( 1 R—
Name 1 �� �'�+ � ase # o
Date of Cremation 1 4 Co
Time Cremation Started 10
-'[ w pJ
Time Cremation Completed 6 ]y.�
Type of Cont air=er atkv ' [�� 1 1 �f}�ri���� —' St
�P6Q, (' -,,Pig
Remarks :
i
biSPUSit1UN OF unEmnmt) Rr-MntNs
I hereby direct Pine View Crematorium to dispose of the cremjtod
remains as follows :
Mail to
Other arrangements - please specify : `___
If pulverization of cremate remains is requested, check here r/
POLICIES, "ULI=S nNU REC,ULA t i ONS
1. The crematorium will be open for cremations 5 days a wpPN
7 :00 A. M. - 3t30 P. M. Monday-Friday. No Holidays or Sunday-t ,
arrangements Car, be made for Saturday. Prearrangements t,,
telephone for acceptance of remains is necessary.
2. Pine View Crematorium is located on the grounds of the piny
View Cemetery; Quaker Roadj Town of Queensbury.
3. An authorization for cremation properly signed by the nearest
next of kin or other authorized person stating that they do h-
the power and authority to arrange for the cremation of t►,r
remains and to direct the disposition of the cremated remains,
that any personal possessions havo either been removed or m,ay be
destroyed and agree to protect , defend and save harmless ri —
View Crematorium from any and all claims and demands for loss nf
damages which may be made Agairi§t them by reason of or conner- l
with the cremation of said remains and/or disposition of S-11H
remains as directed, whether such Claims or demands are, or Ar'f-
not wholly groundless# false or fraudulent. This authorizlt- 1 1
in addition to a regular bUrial permit must accompany thr?
remains.
4. All remains must be encased in a casket or suitable alternate
container. Casltets and tontainers must be of combustible
Oaterial. No styrafoam or plastic containers will be accepted.
5. Th# question relative to tardiac pacemakers must be an<<,r, '
on tho authorization to cremate form before the remains will (—
accepted.
6. Unless other arrangements are made the cremated remains will
be mailed via Registered U. S. Mail within throe days of crematiot,
to the funeral home handling the service. There will be a 420. 00
Charge for this service.
Cremation, Administration Costs and Recording Fee : Adult 4175. 00
Children (age 13 months to J2 years ) t100. 00 Infants ( stillborn
to 12 months ) 460. 00
�,.
tUWN tlr t1UWtNsAWIY
P I NE v i to CEME t E"Y
CF1f=MgtUn I UM
Uuaker Road, Uueehlbury, New York 12804
Phone (518) CremAtoriuO 745-4477 or if no answtr
Cemetery 745-4476
n(jMu"t zntIUN to CnF-mnTE
The uhdersig"td request 's and Authbriios Pine View Crematorium, in
accordAnce with and sub,jocb t(i itt Ftulls And Regulations to
cremate the remAins of :
F16yd Lee Norton Male
(Name) (S"k)
562 Corinth ,Rd - 9ueensbury. NY 12804
(Street ) (City) (State ) (Zip Code )
who died on 11fh day or Aug>>�t 19 qA
atl-21.,000 Falia Hnf--.,;t 1 100 Park Street Glens Falls, NY 12a01
(Place) (Addrlse)
Name and addrE34 of nearfst living relative or ha1p(p of person
duthbrizing cremAtibht
Mrs. Carol P. Morton RD 2 Box 205
(NA fnp) (Addrel3)
ntlatibhship to the deceA4#d Dauclhter-in-Lav
Name bf Punordl NoMeCar-leton Funeral Home Inc
3 MiPtln T FINT
I pstnt that to the bust of icy 'kmowledg@, the deceased has or
as t1b at**Akef- it, hit br her body: (circle one)
I tlrtify that l hAvt th* full powof- and authorization to arrange
for the crOma*tibn of the remain3 And to direct the disposition of
the crtMated i-tMAihsi that any ptrsbhal pb40,E*4ions have either
beeh rtAovpd ot- May bA dtktrby§di And agree to protect , defe►ld
and tave harmless Pine VieW CrOAAtorium from any and all claims
and d@mands for loss or dAmdgtt which may be made Against them by
rogtkbri of or cohnfcted with th# treaation of *aid romains as
directed, whether §uch (=1diA4 br d#mAnd* are or are not wholly
g , oundlt§s, false or ffrAudulpnt4(, (�/� r � Q
S'f ��1�,s -) J Z 1 YU-/ C Z 1
,� (Witness) (Address)
(Signature of RelAtivt or L6gAI Rpp. and Address)
Signed on thi +t dAtot 1/ 7 J� C