Downie, Catherine TOWN OF QUE9SVBU9?1Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name P-0 ow Case #i
Date of Cremation /Time Cremation Started
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Time Cremation Completed 01,06 1-91m;\
Type of Container 4-IVD(_cf
Remarks : lei
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TOWN OF QUEENSBURY /1
PINE VIEW CEMETERY
a
CREMATORIUM
Quaker Road, Queensbury, New York 12.804
Phone (518) Crematorium 745-4477 or if no answer
Cemetery 745-4476
AUTHORIZATION TO CREMATE
The undersigned requests and authorizes Pine View Crematorium, in
accordance with and subject to its Rules and Regulations to
cremate the remains of:
Catherine M. Downie Female
(Name) (Sex)
Wesley Health Care Center Saratoga Springs, NY 12866 USA
(Street ) (City) (State) (Zip Code)
who died on 22nd day of Nov. 19 96
at Ahni,o
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation:
New South Wales
Jean Downie 119 Walks Road Curra Juan Heights Australia 2758
(Name) (Address)
Relationship to the deceased daughter
Name of Funeral Home Wjlliam T RiirkP 9 Sons Funeral Hnme
IMPORTANT:
I resent that to the best of my knowledge, the deceased k
has no acemaker in his or her body. (Circle One)
I certify that I have the full power and authorization to arrange
for the cremation of the remains and to direct the disposition of
the cremated -emains, that any personal possessions have either
been removed or may be destroyed, and agree to protect, defend
and save harmless Pine View Crematorium from any and all claims
and demands for loss or damages which may be made against them by
reason of or connected with the cremation of said remains as
directed, whether such claims or demands are or are not wholly
grtoundless, faL.1e or fraudulent.
X � /_ 1"6 i:�
(Witness) (Address)
(Please print both addresses.)
(Signature of Relative or Legal Rep. and Address)
Signed on this date : November 24, 1996
DISPOSITION OF CREMATED REMAINS
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 x
POLICIES, RULES AND REGULATIONS
1. The crematorium will be open for cremations 5 days a week
7:00 A. M. - 3:30 P. M. Monday-Friday. No Holidays or Sundays,
arrangements can be made for Saturday. Prearrangements by
telephone for acceptance of remains is necessary.
2. Pine View Crematorium is located on the grounds of the Pine
View Cemetery, Quaker Road, Town of Queensbury.
3. An authorization for cremation properly signed by the nearest
next of kin or other authorized person stating that they do have
the power and authority to arrange for the cremation of the
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 Pine
View Crematorium from any and all claims and demands for loss of
damages which may be made against them by reason of or connected
with the cremation of said remains and/or disposition of said
remains as directed, whether such claims or demands are, or are
not wholly groundless, false or fraudulent. This authorization
in addition to a regular burial permit must accompany the
remains.
4. All remains must be encased in a casket or suitable alternate
container. Caskets and containers must be of combustible
material. No styrafoam or plastic containers will be accepted.
5. The question relative to cardiac pacemakers must be answered
on the authorization to cremate form before the remains will be
accepted.
6. Unless other arrangements are made the c;'emated 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 Recording Fee: Adult $185. 00
Children (age 13 months to 12 years) t11.0. 00 Infants ( stillborn
to 12 months) $70. 00
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25-NOV-96 MON 10:46 VIROLOGY DEFT FAX NO, 61 2 6335314- P, 02
.I
TOWN QF QUECNSBURY
PING VIeW CEMETERY
CREMATORIUM
•Quaker, mead, .Quecnsbury, Now York IR004
Phone f1518), Crematorium 7A5-4477 or ' i f no answer
Cemetvwy 745-41176
AUTHORIZATION TO CREMATE
The uodersigned requests and authorizes Pine View Crematorium, in
accordance with An•d subject to it-, Rules and Regulations to
cremator the refflain's WI
Catherine M. Downie
(Name) (Sex)
Wesley Health Care Center Saratoga Springs, NY 12866 USA
(street) (city) (State), (zip Coda)
who died on 22nd _ ,day of Nov. 19 96
At
Name and arddrest o'f nearest 1tving relative or n*M• of parson
oxutharizing cremations 3J:> ,
New South Wales
Jean Downie 119 Walks Road Curra Juan Heights Australia 2758
(N4me) .; i. r6.i(Addr,yss) .
Ralationship to tho d(2ce1ased J daughter
Name of Funeral Nome-i-1.1 I,T ,x_ runf-ral II)Me
I MPUATANT a
as#nt that t v the best of my 14nowl edge? the deceased i+ ±�^
has no pac@maker in his or her body.._,: ,.(Circle One)
I certify that I have the full power and author. izatlon to arrange
for the crvmatiQn 6fi the reinai-ns and' t,v direct the disposition of
the cremated on,y' persa'hal possessions have either
been removed or may b,e destroyndj and agree to protect] defend
and bev$ harml0s.s Ping Uiew Cr.ematorium from any and all claims
j and domAnds for` lass" or^ 'ddmages Oh'ich` may be mada against then by
roason of or connected with the t:remation of said remains as
directed, whether' 'suc�li C"I ims ,'p,r; -dparabds aro or are not wholly
groundless, , falzu or fraudultant.
(Witnvss) cpd rQas> �ls0WS0NCg. GK5,(+TS NSA Z.i
X �, (Please print both addes.
(signat(1 o . of Relative or'Legal Rep. and Address)
Signed on this 'dataRs"' �.".-` N�gd*r 24, =1996