Greenlaw, Laura 70'74N OF QUEEVBURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director Cti EtO N -- t
t V I` C (� 1
Name N Case #
Date of Cremation
Time Cremation Started �1_ 1 ✓V1
Time Cremation Completed ) 2 -
Type of Container Ci
Remarks:
Ala
i
DISPOSITION OF cnEmm ED RrMnINS
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, 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 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 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 ha• v,
the power and authority to arrange for the cremation of thq-
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 Pino
View Crematorium from any and all claims and demands for loss nf
damages which may be made against them by reason of or connectnci
with the cremation of said remains and/or disposition of sal •l
remains as directed, whether such claims or demands are, or -ire,
not wholly groundless, False or fraudulent. This authorizi- t •••,
in addition to a regular burial permit must accompany tt��
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 anst-or-4
on the authorization to cremate form before the remains will t—
accept ed.
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 $20. 00
charge for this service.
Cremation, Administration Costs and Recording Fee : Adult $ 175. 00
Children (age 13 months to 12 years ) $ 100. 00 Infants ( stillborn
to 12 months ) t60. 00
r.
TOWN OF U(JEENSOURY
PINE VIEW CEMETERY
t
CREMATORIUM
Quaker Road, Oueensbury, New York 12804
Phone (518) Crematorium 745-4477 or if no answer
Cemetery 745-4476
AUTHORIZATION TO CREMATE
The undersigned request 's and authorizes Pine View Crematorium, in
accordance with and subject to itt Rules and Regulations to
cremate the remains of:
[.aura Sra�:ca Green 1 av Female _._..
(Name) (Se)0
7244 Upper, Broadway Fort Edvard, NY 12828
(Street ) (City) (State) (Zip Code)
who died on 19th day of April 19 96
at 7244 U . Broadway, Fort Edward , NY
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation:
Kathleen LaBelle 10 James Court Glens Falls , NY 12801
(Name) (Address)
Relationship to the deceased Special Friend
Name of Funeral Home Carleton Funeral Home Inc.
IMPORTANT:
I represent that to the bQs , of say knowledge, the deceased has or
has no pacemaker in his or her body. (Circle One)
I certify that I have tho full power and authorization to arrange
for the cremation of the remains and to direct the disposition of
the cremated remains, that any ptrsonal pott*ssions have either
been reeioved 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 t-rremation of said remains as
di cted, whether such claims or demands art or are not wholly
ro 1 s fals or fraudulent.
Carleton Funeral Home , Inc .
SWitness) (Address)
Glens Falls , NY
(Signature of Relative or Legal Rep. and Address)
Signed on this date :