Smania, Natalie n�
s
zo,xN off" QUEEVBURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
6uwe rya�( "/0ly
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Name 1 �r` -'-5-__A I�7� Case # -�
Date of Cremation n —�b
Time Cremation Started
Time Cremation Completed_ - f /�V AM)
Type of Contained
Remarks :
11 �1 %�02�•n�1 ,
t o"N tw UOttNSAO"Y
aINE VI�N t:EMEtEftY
t"tHntURtUM
Quaker Road, Que06nlbury, New Yorl< 12804
Phone (518) CremAtorival 745-4477 or if no answer
Cemetery 745-4476
AUtltuni ZntiUN ttl t:R mnm
The uhdersigned request 's and aluthoriils Piny+ View Crematorium, in
accordAnce with and subject tti iti Rul#t And Rbgulations to
cremate the reMains of :
Natalie R. Smania Female
(Name) (Serf)
ll✓aS��. -�vaciS
1121 Maple St (Kinasbury� NY 12839 _
(Street ) (City) 11 (State ) ( Zip Code)
who died on let day tit August 19__95
Atnipng F is Hnm it l in PArig gf____t Glens Folio. NY r�nnl
(Place) (Addr064)
Name and addr@44 of nearOtt living I-olative or naml of person
Authbrizing cremAtibh!
MrS. Carol Jones
tNalre) (Addr@s4)
Relatiohthip to the dotfakod nalighter
No** bf PunerAl Home
lMPOR7nNT
t r,#pr4ent than to the blot of my knowledge, the deceased has or:
�4 nb atl*aker in hit br ho• - bbdya Wli-cll Unl)
I ttrtify that t hav* th* full pow#th and *uthorization to arrange
for the crtmation of thb roomin4 And to dirlct the disposition of
th@ ct-@Nated reMAih%4 thAt ahy plr+kbhAl pb4t*44ions havd either
b4eh reAovbd or may by do§trby§dt And agrel' to protbct, defet'd
and §ave harOlOss PinO View Crematorium from any and all claims
and doffiand4 for loss or d6069#4 Whith may be made against them by
Yrea4on of or cbhnectod with tho ti-OMAtion of *aid remains as
direc ed, whether such tlaiiiti4 or d6mmnd4 Arl or art not wholly
grow legs, false or frgudOlent:
(WiEne4s) (nddr@ts)
Oj-
(Sig ure of ' Relative br Llgal Rep. and Addre s)
C
Signed on thit dates
DtSpflStt1UN OF cnr=Mt1TEU Pr-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 regUested, check here ✓
PULtCiES, RULES AND "EGULAT"IONS
1 . The crematorium will be open for cremations 5 days a wppir
7 .ee A. M. - 3: 30 P. M. Monday-Friday. No Holidays or Sunday, ,
arrangements can be made for Saturday. Prearrangements ► ,
telephone tar acceptance of remains is necessary.
2. (pine VieW Crematorium is located art the grounds of the Pin"
View Cemeteryi Uual(er ROadi Town of Uueensbury.
J. An authorization For cremation properly signed by the nearpat
"oRt of kin or other authorized person stating that they do
the power and authority to arrange for the cremation of tl,n
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 Pity"
View Crematorium from any and all claims and demands for loss nf
damages which may be made agaitist them by reason of or connectn,i
with the cremation of said remains and/or disposition of sari
remains as directed, whether such claims or demands are, or mr-r-
not wholly groundless► false or fraudulent. This authoriz�i(- i —,
in addition to a regular burial permit must accompany tllr?
remains.
4. All remains mutt by encased in a casl(et or suitable alternate
tontainpr. Catitets and tonidiners must be of combustible
material . No styrafaam or plastic containers will be accepted.
5. Th@ question relative to tardiac pacefnakers must be anci;—
on tho authorization to cremate+ form before the remains will t,(-
accept6d.
6. Unless Other arrangertients 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 Pecording Fee : Adult 1175. ,d0
Children (age 13 months to 12 years ) 4100. 00 Infants ( stillborn
to 12 months ) 460. 00