Wyant, Edward OF QUEEVBU-0�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director )L
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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 under requests and authorizes Pine View Crematorium,in accordance with and subject to its Rules and Regulations to
cremate the remains of:
Edward E. Wyant Sr Male
(Name) (Sex)
232 Barton Mines Rd. , North River, NY 12856
(street) (City) (State) (Zip Corte)
who died on 7 t h day of June 20 06
at his home (same as above)--
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremation:
Edward E. Wvant Jr. , PO Box 231 , North River, NY 12856
(Name) (Address)
Relationship to the deceased S o n
NameofFuneraiHome Alexander FH, Inc. , North Rivet/ NY
IMPORTANT:
I represent that to the best of my knowledge,the deceased(t*KOt(has no)pacemaker,defibrillator or any other battery operated
device in his or her body. (Circle One)
II ceem�t have that "` autho ilzation to arrange for the cremation of the remains and to direct the disposition of the
Personal possesslons have either been removed or may be destroyed,and agree to praeect,defend and
save Pie Crematorium kim any and aM debts and demands for loss or damages which may be made age them
- or with the cremation of said remains as directed,whether such claims or demands are or are not wholly
groyrdess, or ftaudulent.
Warrensburg, NY
(witness) (A )
��w tub 'i "ZG+- PO 6 a x z-" l L4 YD 7 f2 i 2,',6 ,lJcr�h D�, ✓�,� s.� C�
(Signature and Address of Relative or Legal Representative)
Signed on this date: 6-7-0 6
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as foltows.
Mail to
Other arrangements-Please specify: F H will nick a n
If pulverization of cremated remains is requested,check here x
Revision:January 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 7:00am 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 pions
have either been removed or may be destroyed and agree to protect,defend and save
harmless Pine View Cemetery and Crematorium from any and sit daims,an 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 styrofoarn or plastic containers will be accepted
4. Cardiac pacemakers,defrbriilators or other battery operated devices must be removed
before any remains will be accepted,
5. Cremations will be completed within three Working days Burial Transmit Permit and Authorization to ormm.The crernated n.maif receipt of ns will
be mailed via Registered U. S.Mail within three days of cremation to the funeral home
handling the service unless other arrangements are made.There wilt 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 Mmonths) $125.00
Overtime Cremations(Weekdays) $450.00
Saturday Cremations $450.00