Greco, Barbara rrn,+N oF QUEEN,
v5BURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director J�U/�Q/�n/gC'k'
Name �RA l'i�� Case #
Date of Crematicn_J— --7- / —'I /
Time Cremation Started I
Time Cremation Completed �/ o`Cl / �AA
T y p e o f C o n t a i n e r 0 rt--?
Remarks :
1476 bl� 2? /;�;.'Z?
rP, rn
!f �1 s
DISPOSITION OF CREMATED REMAINS
I hereby direct Pine View Crematorium to dispose of the cremates
remains as follows :
Mail to
Other arrangements - please specify :
If pulverization of cremate remains is requested, check here
POLICIES, RULES AND REGULATIONS
I . The crematorium will be open for cremations 5 days a wee,
7 :00 A. M. - 3:30 P. M. Monday-Friday.
iday. No lidays or Suns ,
arrangements can be made for Saturday. Ho Prearrangementdsayny
telephone for acceptance of remains is necessary.
2. Pine View Crematorium is located on the grounds of the pine
View Cemetery, Quaker Road, Town of Queensbury.
3. An authorization for cremation properly signed by the nearest
next of kin or other authorized person st:Ating 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 to
destroyed and agree to protect, defend and save harmless pine
View Crematorium from any and all claims and demands for loss o '
damages which may be made against them by reason of or connecter
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 authorizatior•
in addition to a regular burial permit must
remains. h accompany the
4. All remains must be encased in a casket or suitable alternate
container. Caskets and containers must be of combust : o : e
material. No styrafoam or plastic containers will be accepted.
5. The question relative to cardiac pacemakers must be answer-ec
on the authorization to cremate form before the remains wall e
accepted.
6. Unless other arrangements are made the cremated remains w1 : .
be mailed via Registered U. S. Mail within three days of cremat : c_
to the funeral home handling the service. There will be a s2o. o-,�
charge for this service.
Cremation, Administration Costs and Recording Fee : :
Children (age 13 months to 12 years) s100. 00 Infants cst : : lco Adult s175. :;--
to 12 months ) $60. 00
TOWN OF QUEENSBURY
PINE VIEW CEMETERY
i9-
CREMATORIUM `� C
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:
wf
Barbara L. Greco Female
(Name) (Sex)
RD #1 , Box 666 , Beaver Pond Rd , Brant Lake , N . Y . 12815
(Street ) (City) (State) (Zip Code )
who died on 23 rd. day of May 1997
at Glens Falls Hospital, Park St., Glens Falls, N.Y. 12801
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation :
Barbara L . Greco , Box 666 , Brant lake , N . Y 12815
(Name) (Address)
Relationship to the deceased Self - Prearrange
Nave of Funeral Home Adirondack Cremation Associates
IMPORTANT:
I reeresent that to the best of my knowledge, the deceased has or
A kk N pacemaker in his or her body. (Circle One )
I certify that I have the full power and authorization 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 Crematorium from any and all claims
and demands for loss or damages which may be made against then by
reason of or connected with the cremation of said remains as
directed, whether such claims or demands are or are not wholly
groundless, f ise
. o-p fraudulent .
( itn ss> (Address)
_A %A fact-,—
.
(Signature of ReJ4 ive or Legal Rep. and Address)
Signed on this date ; May6 , 1996