King, Edward tot4N or UUttNstlUtty
PINE VIOLA CEHEtE"y
t✓"EHntoR I uH
Quaker Road, Quetnlburyt New York 12804
Phone (518) Crematorium 745-4477 or if no answtr
Cemetery 745-4476
nui1-IoRI zAtluN to CREMnTE
The undersigned request 's and authoriies Pine Vier) Crematorium, in
accordAnc* with and sub,j@ct tti it4 Rut@@ And Rbgulations to
cremate the remains of *
Edward William King male _._ .
(Name) (Sept)
27 Briwoo,d Circle Queensbury NY 12804
(Street ) (City) (State) (Zip Code )
who died on 14th day of October 19 96
at Glens Falls Hospital Park Street , Glens Falls , Nv
(Place) (Addr0e4)
Name and addr644 of nearott living relative or ham* of person
authbriting crematibh !
Mrs Mary King 27 Briwood Circle Queensbury, NY 12804
(Na(ne) (Addy-#W
R#latiohehip to th@ deteatod wife
Name bf KunerAl Hom@ Carleton Funeral Home Inc .
1MponlnW e
\f I rrpre9ent that to the be4t of my knowledge, the deceased has or
has rib pacf*.*ker ih hit br- hot- body: (circle one)
I tertify that I hav6 thb full power And authorization to arrange
for the creMatibn of the And to diroct the disposition of
thr cv-#N&tsd remaihs; thAt ahy ptl^4bhA1 po446+49ions have either
b#Oh reilovtd b.r may be dp§Erbytd! And agre@ to prbt6ct , defe„Ii
and §ave harmless Pine VieW Crematorium from any and all claims
and d@mandt for loss or dAM6904 which may be made Against them by
reaSdn of or cohn@cted with th# ti-tmAtion of *aid rtmains As
directed, whether SUch c14144 bf^ dfmbnd4 Art or are not wholly
g oU le4e alsp `r frAUdulent:
Carleton Funeral Hnma nr
tWitnp45) tAddre4s)
ueensbur NY 12804 '
(Si attire of lAtive br LtgAl Rep. and Address)
Signed on thi4 date !
b I SPl1S 1 t 10N OF CnEMR 1 E1) nr Mn I N5
I hereby direct Pine View Crematorium to dispose of tf,e cremated
remains as follows :
Mail to
Other arrangements - please specify :
If pulverization of cremate remains is requested, chect< here
PULICIES, nULP-S ANU nEGULnttoNS
1 . the crematorium will be open for cremations 5 days a walk
7 :00 R. M. - 3: 30 P. M. Monday-Friday. No Hotidays or sund.ay� ,
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 Pint,
View Cemetery] Qual<er Road, Town of Oueensbury.
3. An authorization for cremation properly signed by the neart,gt
next of kin or other authorized person stating that they do hivr'
the power and authority to arrange for the cremation of tf,r
remains and to direct the disposition or the cremated remains,
that any personal possessions hav@ either been removed or may be
destroyed and agree to protect, defend and save harmless Pine
View Crematorium trom any and all claims and demands for loss nf
damages which may be made against them by reason of or connect -0
with the cremation of said remains and/or disposition of sa ►r1
remains as directed, whether such claims or demands are, or ?r-r
not wholly groundless~ false or fraudulent. This authoriz0- i
in addition to a regular burial permit must accompany thf?
remains.
4. All remains must by encased in a casttet or suitable alternate
tontainer. Casliets and tontainers must be of combustible
Material . No styrafoam or plastic containers will be accepted.
5. Tho question relative to cardiac paceMakers must be anst,r—
on th@ authorization to cremate form before the remains will t �
accepted.
6. Unless other arrangements are made the cremated remains will
be Mailed via Registpred 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 W 5. 00
Children (age 13 months to 12 years ) t100. 00 Infants ( stillbo*-n
to 12 months ) t60. 00