Prouty, Eleanor t oWN W butt"sgUny
bINE VIt" C:EME1EhY
a
t"tH a?UR IUM
Quaker Road, Uue@"4bUry, New York 12804
Phone (518) CrematoriUA 745-4477 or if no answer
Cemetery 145-4476
nUtNU"I Znt1ON ftl CREMntE
the uhdersigned request 's and authbriibs Pine View Crematorium, in
accordAnce with and sub,joct t6 it3 nule+i and Rbgulations to
cremate the remains of :
Eleane:r • Mae Prouty _ fc-m 1 P
(Name) (S@k)
Hendee Road Tn o 12839
(Street ) (City) (Statb ) (Zip Code )
who died on 16th day df
October iq 96
at Glens falls Hospital , Glens Fall
(Place) (Addrls+! )
Name and addrte3 of nearest living rtlative or "AM6 Of person
authbrizing crematib"
Mr . Dorr E . ProutY , RD2 Box
`A .5d67��§Hudson Falls NY
(NAMIP)
Relatiohthip to the decogtod Husband
Namo of Funeral Name Carleton Funeral Home Inc .
1Mp(jnjIIHTt y g the deceased has or
1 re resent that to the best of kriowled e,
ha ►1b pat#*.jkei^ it, hie br hot- bbdy: (Circle On!)
I tOrtify that 1 hAV6 tht full power and authorization to arrange
for the crtMatibn of the 1-60Ain3 And to dirlct this dispatition of
tfie ct-voAtod i-OMA ihs; thAt ahy pth3bhAl poe§63§ ions have either
beeh Y'rAoved or may by dottrbyedi And agr0e to protect, defe"
and §ave harmless Pine View Crj?44torium from any and all claims
and d@mandt for loss or damagpf which may be made against them by
r-e�sbn of or cohnfctod with tht thematibn of said remains as
directed, whether Ouch i=1911i9 or dbM&nd4 ar# or are not wholly
ground bS§, fa s fraudulent:
ar e on Funeral Home Inc .
tWitnp§s) (Address)
Tn olf Kin sour NY
(Signotur of R lativo or l.lgfil Rpp. and Address)
Signed on thi3 date :
U I SPUS i t I ON OF CnEMF11 EI) Itr-Mn I NS
I hereby direct Pine View Crematorium to dispose of Elie cremated
remains as follows :
Mail to
Other arrangements - please specify : _____
If pulverization of cremate remains is requested, check here
POL I C l ES, nuLtS nNU "r=GuLA t I ONS
1 . The crematorium will be open For cremations 5 days a week
7 :00 A. M. - 3430 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 Pinp
View Cemetery; Quaker noadt Town of Glueensbury.
3. An authorization for cremation properly signed by the nearest
next of kin or other authorized person stating that they do h -ivf,
the power and authority to arrange For the cremation of t:l—
remains and to direct the disposition or the cremated remains,
that any personal possesslohs have either been removed or may be
destroyed and agree to protect , defend and save harmless Pitip
View Crematorium from any and All claims and demands for loss nr
damages which may be Made Agairitt them by reason of or conner:1—i
with the cremation or said remains and/or disposition of sail
remains As directed, whether such claims or demands are, or arrr
not wholly groundless~ false or Fraudulent. This authorizi�- i
in addition to a regular burial permit must accompany tl-e
remains.
4. All remains must be encased in a casl►et or suitable alternate
container. Caskets and tontainers must be of combustible
Material . No styrafoam or plastic containers will be accepted.
S. The question relative to cardiac pacemakers must be ancts—
on tho authorization to cremate form before the remain% will t'v
accepted.
6. Unless other arrangements 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 420. 00
tharge for this service.
Cremation, Administration Costs and Recording Fee , Adult t175. 100
Children (age 13 months to 12 years ) t100. 00 Infants ( stillborn
to 12 months ) t60. 00