Schneider, Mark TUMN OF QUEENSB`Ll9?T
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director A j C-jK -A A/d'e- r iqk-P t-
Name M A R Kph lv F i ei �; rc� Case # <�
Date of Cremation ��� 7
Time Cremation Started -1 3d iq T
Time Cremation Completed P, ry)
Type of Container C C.i� S dct Th E ,D4y
Remarks : \
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DISPOSITION OF CREMATED REMAINS
I hereby d rect Pine View Crematorium to dispose of the emate
remair s as ollows :
Mail to
Other arrancements - please specify :
If pul ,,eriza : ion of cremate remains is requested, check here
POLICIES, RULES AND REGULATIONS
1 . Th crematorium will be open for cremations 5 days a wee
7 :00 A. M. - 3 : 30 P. M. Monday-Friday. No Holidays or Sundays ,
arrangements can be made for Saturday. Prearrangements
telephone fo - acceptance of remains is necessary.
2. Pine Viej Crematorium is located on the grounds of tr)e P1ne
View Cemeter ,, Quaker Road, Town of Queensbury.
3. An authcrization for cremation properly signed by the nearer :
next of kin r other authorized person stating that they co have
the power nd authority to arrange for the cremation or t ^e
remains and to direct the disposition of the cremated remains ,
that any pe sonal possessions have either been removed or may �e
destroyed a d agree to protect, defend and save harmless Pine
view Cremato ium from any and all claims and demands for loss o
damages whit may be made against them by reason of or connectec
with the cr, mation of said remains and/or disposition of sa : c
remains as d rected, whether such claims or demands are, or are
not wholly roundless, false or fraudulent . This author : zat : :--
. n addition to a regular burial permit must accompany the
-emains.
i. All remains must be encased in a casket or suitable alternate
_ontainer. Caskets and containers must be of combust : c : e
i4aterial . Nc styrafoam or plastic containers will be acceptee .
5. The question relative to cardiac pacemakers must be answerer
;n the authorization to cremate form before the remains " Ili
accepted.
Unless ether arrangements are made the cremated remains
)e mailed via Registered U. S. Mail within three days of cremat : __ _
o the funeral home handling the service. There will be a
charge for this service.
Cremation, Adlinistration Costs and Recording Fee : Adult $ 1 -75. -
Children (ag , 13 months to 12 years) $ 100. 00 Infants ( st : : 1 t o 12 months ) $60. 00
n
TOWN OF DUEENSBURY
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road, Queensbury, New York 12804
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:
Mark E. Schneider Male
(Name ) (Sex)
RR 1, Box 12, Coolidge Hill Rd. , Diamond Point, NY 12824
(Street ) (City ) (State) ( Zip Code )
w h o died on 15th d a y of Jan. 1 9 97
at Ludlow, VT.
(Place) (Address)
Name and address of nearest living relative or nave of peg-som
authorizing cremation :
Mr. Raymond A. Schneider, 4190 Clardon Dr. , Williamsville, NY 14221
(Nave) (Address)
Relationship :o the deceased Father
N a m e o f F u n e r i I H o m e Alexander-Baker FH, Warrensburg, NY
IMPORTANT:
I represent t ,at to the best of ray knowledge, the deceased )QQQP0(X
has no pacema <er in his or her body) (Circle One )
I certify tha ; I have the full power and authorization to arrange
for the crema ; ion 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 , defenc
and save harmless Pine View Crematorium from any and all claims
and demands for .loss or damages which may be made against there by
reason of or connected with the cremation of said remains as
directed, whether such claims or demands are or are not wnoliY
gr undI s false or fraudulent .
Warrensburg,NY
(Witness ) (Address)
X
(S gnature of Relative or Legal Rep. and Address)
Signed on this date :__ -/7 Q,