Kenyon, Christine "'O`14N OF QUEEVBU9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director A.Lf A-4 e4
Name e- Lg ,A Case# f G
Date Of Cremation /:Z --UG
Time Cremation Started S P'^
Time Cremation Completed " f0 Pjht
Type of Container_ -AraL )0 2Jd CASz ui P
Remarks
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Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road, Queensbury, New York, 12804
Cemetery Office: (518)745-4476,Crematorium: (518)745-4477
Authorization to Cremate
The undersigned reams and authorizes pine View Crematorium,in accordance with and sum to its Rules and cremate the remains of Regulations to
Christine Kenyon Female
( ) (Sex)
PQ Box 604 Warrensburg, NY 12885
(street) (City) (State)
(Zip Code)
who died on 7 t h day of May 20 06
at Glens Falls Hospital , Glens Falls , NY
(Ptace) (Address)
Name and address of nearest living relative or name of person authoring cremation:
Carson Kenyon, 84 Alden Ave. , Warrensburg, NY 12885
(Name) (Address)
Relationship to the deceased S o n
NameofFunermHorne Alexander-Baker Funeral Home
IMPORTANT.
I represent that to the!test of my knowwledge,the deceased MWOr(has rho)pacemaker,defibrillator or any other battery operated
device in his or tw body. (Circle One)
I certify that I have U power and authormfion to arrange for the cremation of the rerrains and to chid the disposition of the
cremated personal possessions have either been rerrroved or may be desvoYecL and agree to protect,defend and
save�#�e V C 38tDriuet from any and all claims and demands for loss or damages which may be made against them
of or wilh the cmrrratlon of said remains as directed,whether such claims or demands are or are not wholly
groundless, fraudulent
Warrensburg, NY
(Wilr►ess) (Address)
Warrensburg, NY
(Sign6ture an4,AMress of Relative or Legal Representative)
Signed on this date: 0 5/0 7/2 0 0 6
Disposition of Cremated Remains
1 hereby direct Paine View Crematorium to dispose of the cremated remains as follows:
Mail to
Other arrangements-please specify: r t n to Alexander-Baker Funeral Home
If pulvef¢ation of cremated remains is requested,check here X r
Revision:January 1,2006
Policies. Rules and Regulations
Pine View Crematorium is located on the grounds of Pine View Cemetery.The
crematorium operates Monday through Friday from 7:00am 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 daims and demands
for loss of damages which may be made against them by reason of or connected with
the cremation of said remains andlor 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 altemate container.Caskets and containers
must be of a combustible material. No styrolbam or plastic containers will be accepted.
4. Cardiac pacemakers,defibnllators or other battery operated devices must be removed
before any remains will be accepted.
5. Cremations will be completed within three wod*V 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
handitng the service unless other arrangements are made.There will be a$30.00 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,�rnonths) $125.00
Overtime Cremations(Weekdays) $450.00
Saturday Cremations $450.00