Rabideau, Mary "q+N OF QUEEVBU,9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director_ M 3 C A
Name ��, Rm ��dc,AL� Case# a
Date Of Cremation
Time Cremation Started 'To HI`1
Time Cremation Completed (, 4l`�
Type of Container CSr cl ']- I St
Remarks
I.
ff� S7n/i ,'
Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road, Queensbury,New York, 12804
Cemetery office:(518)745-4476, Crematorium: (518)745-4477
Authorizatiorl to Cremate
The undersigned re09sts and su8mrizes Pine View Crematorium.in accordance with mid subject
to its Rules and Regulations to
cremate the remains of.
Mary L. Rabideaix Female
(Sex)
r3 ti NY 1 ��4h
(Stn:e�J (City) (StA4e) (Zip code)
who died on �Q 9 t h : . _ ..-- day'Df_ Ma,X . ��
at fJihlein Merc�Center, Old Military Rd.Lakz Placid, NY
(Place).
Name and address of nearest living relative or name of person authorizing cremation:
3.hd
222 State Rte 86 . P mi_hs, NY 12970
Edward- Rabid O
(Name)
Relatidriis*t6 ttie deed_. Son ---- _
Name of Funeral Home — —
2310 Saranac Ave.
IMPORTANT; the decea� &V �,�Of or any other banery operated
I represent that to the best of my Imo,
device M his or her body. (circle One)
1 certify that I have:11u8 povlrar and authorization to arrange for the cremation of the remains and to direct the disposition of the
otect,defend and
cremated rernains.lha?any personal p ns have either been removed or may be destroyed.and agree
to made against them
save hanriiess Pkiel V+W Crematorium ftoFn any and all claims and demands for loss or damages Which may
by reason Of&connected with the ownstion'of said remains as dated,wtnatFter such dtrims tx demands are or are not wholly
groundless false or frauciuient.
2310 Saranac Ave. , Lake _Placid. NY 12946
(Witness)
._s,�._._..—_.____.----•------(Address)__...._....__
• _ 22 State Rte 86, Patxl Smiths, NY 12970
(Signature and Address of Relative or Legal Aepresentsirve)
Signed on this date:_ M a r 9, 2006
-
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as foltows:
A.M. Oark.3nr.
Mail to -
Lake
Other arrangements-Please spedfy: ----—-if pulverization of cremated remains is requested,check here _
Revision:Jarxrary 1.2006
Policies, Rules and Regulations
1. Pine View Crematorium is located on the grounds of Pine View Cemetery. The
crematorium operates Monday through Friday from 7:OOam to 3:30pm. Prior telephone
arrangements for the acceptance of remains are necessary. Prearrangements are
necessary for Saturday cremations.
2. A "Authorization for Cremation"signed by the nearest next of kin is necessary 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 Cemetery and 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 are, or are not wholly groundless,false or fraudulent.This authorization in
addition to a regular burial permit must accompany the remains.
3. All remains must be in a casket or suitable alternate container. Caskets and containers
must be of a combustible material. No styrofoam or plastic containers will be accepted.
• 4. Cardiac pacemakers, defibrillators or other battery operated devices must be removed
before any remains will be accepted.
5. Cremations will be completed within three working days(72 hours)of receipt of the
Burial Transmit Permit and Authorization to Cremate Form.The cremated remains will
be mailed Via°Registered U. S. Mail within three days of cremation to the funeral home
handlirig`the service unless other arrangements are made. There will,be a $34.00 charge
for this service.
6. Cremation, Administration Costs and Recording Fees:
Adult $325.00
Children (age 13 months to 12 years) $175.00
Infants (stillborn to 12 months) $125.00
Overtime Cremations (Weekdays) $450.00
Saturday Cremations $450.00