Wilde, John .tiflr'ifc.S.�Ls�•'. .
TO OF QUEEN4w5BU9?ry
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director ► r�(�l 8,0Kc �
Name 1 �� ' `� W ) �C� Case 0_`7 LI
Date of Cremation
Time Cremation Started �- r
C
Time Cremation Completed
Type of Container C A r G+ rei l �Sf�S`� C? �A1L
Remarks :
G
/ P
DISPOSITION OF CREMATED REMAINS
I hereby d . rect Pine View Crematorium to dispose of the cremate
remains as 7ollows :
Mail to
Other arrangements - please specify:
If pulveriza ; ion of cremate remains is requested, check here
POLICIES, RULES- AND REGULATIONS
1 . The crematorium will be open for cremations 5 days a 4ee -
7 :00 A. M. - 3: 30 P. m. Monday-Friday. No Holidays or -Sundays ,
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 dine
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 have
the power and authority to arrange for the cremation of tre
remains and to direct the disposition of the cremated remains ,
that any personal possessions have either been removed or may :e
destroyed and agree to protect, defend and save harmless p : ^ e
View Crematorium from any and all claims and demands for loss 37
damages which may be made against them by reason of or connectec
with the cremation of said remains and/or disposition of sa : c
remains as directed, whether such claims or demands are, or are
not wholly groundless, false or fraudulent . This author ; zat : :�-
in addition to a regular burial permit must accompany tie
remains.
4. All remains must be encased in a casket or suitable alternate
container. Caskets and containers must be of combust : :material . No styrafoam or plastic containers will be accepted. e
5. The question relative to cardiac pacemakers must be answe-ec
on the authorization to cremate form before the remains " Ili
accepted.
6. Unless other arrangements are made the cremated remains .be mailed via Registered U. S. Mail within three days of eremat : __--
to the funeral home handling the service. There will be a
charge for this service.
Cremation, Administration Costs and Recording Fee : Adult
Children (age 13 months to 12 years ) s100. 00 Infants to 12 months ) s60. 00
TOWN OF QUEENSBURY
PINE VIEW CEMETERY '
a
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phonc (518) Crematorium 745-4477 or if no answer
Cemetery 745-4476
AUTHORIZATION TO CREMATE
The undersigred requests and authorizes Pine View Crematorium, in
accordance vith and subject to its Rules and Regulations to
cremate the remains' of:
John R. Wilde Male
(Name) (Sex)
Bowen Hill Rd. , HCRO1, Box 116, Warrensburg, NY 12885
(Street ) (City) (State) ( Zip Code )
who died on _ 23th day of Jan. 19 97
at Glens Falls Hospital
(Place) (Address)
Name and address of nearest living relative or nave of person
authorizing c ^emation :
Jane Wilde Same as above
(Name ) (Address)
Relationship :o the deceased Spouse
Name of Funeral Home Alexander-Baker FH, Warrensburg, NY
IMPORTANT:
I represent tiat to -the best of my knowledge, the deceased )QQPPOW
has no pacemcier in his or her body. (Circle One)
I certify thi ; I have the full power and authorization to arrange
for the creAi, ; ion of the remains and to direct the disposition o =the crenated remains, that any personal possessions have eitner been removec or may be destroyed, and agree to protect , derenc
and save harness Pine View Crematorium from any and all claims
and demands f )r loss or damages which may be made against then by
reason of or connected with the cremation of said remains as
dir ted, h ?ther such claims or demands are or are not wnoliy
ground s rilse or fraudulent .
Warrensburg,NY
( itness (Address)
X ` _
Se as above(Signa ue of elative or al Rep. and Address)
Signed on t h i date : 1-23-97