Brennen, Joseph tb"N OF timt=NtA011y
PINE VItu tEMEtEhY 4r—t1 W
c"F-H 1tURIUM
Quaker Road, 0ueeh4bUry, New York 12804
Phone (519) CremAtoriuA 745-4477 or if no answer
Cemetery 745-4476
f1U MUIt I MMIN t t] t;REMA TE
The uhdersigned request 's and Authoriits Piny+ View Crematorium, in
accordAnce with and �sub,jbct id it3 Rupp And Regulations to
cremate thb rt*Ains of :
Joseph D . Brennen M
(Name ) (Se)4)
Smiths Basin Hudson Falls NY 12839
(Street ) (City) (State) ( Zip Code )
who died on 9th day of September 19 96
At Glens Falls Hospital , Glens Falls NY
(Place) (Addr093 )
Name and addrEss of n0alrest living rplAtivp or nAMi of person
Authbrizing cremAtibh !
t3✓tN✓14 611-415
Mrs Margery Brennen, -g4�i -"
� Hudson Falls NY 12839 __
(Name) (Address)
RelAtionship to thb deteAsed wife
Name of punerAl HOMe Carleton Funeral Home Inc .
rppr st that t' the best of my knowledgb, the deceAstd has or
has ftb patto6Akpf^ h hi9 br hot- bbdyj (circip Un!)
I tbrtify that I hAv6 the full poWot- And Authorization to airronge
for the crOmOtion of the 1-6041n3 And to dirlct the disposition of
the ct-#M&tpd I-o*Aihsi thAt Ahy W'4bhA1 po44644ions have+ either
beeh r-#sovpd or may be dpstrbyedi And agree tb prot6ct , defe„H
and tavt harmless Pint VloW CrOMAtorium from any and All claims
and deMands for loss or dAMAgp4 which may be made Against them by
reasoh of or rbhn6ctbd with th# ti'60Ation of said remains as
dir@cted, whether §uch t19144 or d#*Ahds Arf or Art not wholly
gro d Ott, false or fraudult+ntc
C
t itnCssl tAddre+ts )
Hudson Falls , NY
t naturt of Relative br LbgAl Rpp. and
Address>
Signed on thig ttt /Y ��'
nlspusl tioN OF cnEMnTED tir—mmNs
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, "ULtS FIND nEGULnTiUNS
1. The crematorium will be open for cremations 5 days a
7 :00 A. M. - 3 : 30 P. M. Monday-Friday. No Holidays or Sunday
arrangements can be made for Saturday. Prearrangements
telephone for acceptance of remains is necessary.
2. (pine View Crematorium is located on the grounds of the pino
View Cemetery4 Uualcer Rdadj Town of Queensbury.
3. An authorization for cremation properly signed by the nearest
next of kin or other authorized person stating that they do havr
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 pig
View Crematorium from any and Ali claims and demands for loss of
damages which may be made agAttitt them by reason of or connertorl
with the cremation of said remains and/or disposition of sa <<i
remains As directed, whether such claims or demands are, or arrc
not wholly groundless# false or fraudulent. This authorizit- i
in addition to a regular burial permit must accompany thf?
remains.
4. All remains must be encased in a castiet or suitable alternate
container. CAsl:ets and tontaIner9 must be of combustible
Oaterial. No styrafoam or plastic containers will be accepted.
5. Tho question relative to tArdiac pacemakers must be ancii—
on the Authorization to cremate form before the remains will t,
accepted.
6. Unless other arrangements are made the cremated remains will
be Mai led via Flegi stered U. S. Mai I wi thin throe days of cr-emit i rit,
to the funeral home handling the service. There will be a $20. 00
charge for this set-vice.
Cremation, Administration Costs and Recording Feet Adult W 5. 00
Children (age 13 months to 12 years ) 1100. 00 Infants ( stillborn
to 12 months) 460. 00