Weast, Nora zO qW OF QUEEVBURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director 1� /�� �/ L'Z'
Name' l ) (i Y"BSI Case is 02 �
Date of Cremation CJ /6 ) 7
Time Cremation Started
Time Cremation Completed ll:aa 19tM ' -
Type of Container l✓y L�LZ �C�l� '. / 5/i l'!!9�,� oFT/y�j1�
Remarks :
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11 �l `d � 19 �
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U I SPOS I t I UN OF CREMA T E t) R1=Mn I NS
I hereby direct Pine View Crematorium to dispose of tt,e cremated
remains as follows :
Mail to
Other arrangements - please
If pulverization of cremate remains is requested, chk here
POLICIES, "ULE5 nNU RERULn i 11)NS
1 . The crematorium will be open for cremations 5 days a wools
7 :00 A. M. - 3: 30 P. M. Monday--Friday. No tloIiclays or Surnriay� ,
arrangements can be made rot- 1;at11rday. Prearrangements h,
telephone for acceptance of remains is necessary.
2. Pine View Crematorium is located on the grounds of the P 010,
View Cemeteryi Gluaker Road, Town of (lueensbury.
3. An authorization for cremation properly signed by the nearest
next of kin or other authorized person stating than they do ha•:r
the power and authority to arrange for- the cremation of trey
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 rit+v
View Crematorium from any and all claims and demands for los ; - '*
damages which may be made against them by reason of or connect -d
with the cremation of said remains and/or- disposition of 1;Alr1
remains as directed, whether such claims or demands are, or Are`
not wholly groundless, false or fraudulent . This authorizer ••••
in addition to a regular burial permit must accompany t11r,
remains.
4. All remakins must be encased in a casket or suitable alternate
container. Caskets and containers must be of combustible
material. No styrafoam or plastic containers will be accepted.
5. The question relative to cardiac pacemakers must be ancr+�
on the authorization to cremate form before the remains will t,r'
accepted.
6. Unless other arrangements are made the cremated remains will
be mailed via Registered U. S. Mail within three days of cremat. inn
to the funeral home handling the service. There will be a $20. 00
Charge for this set-vice.
Cremation, Administration Costs and Recording Fees Adult $ 175. 00
Children (age 13 months to 12 years ) t100. 00 Infants ( stillborn
to 12 months ) 160. 00
TOWN OF (]I)EENSbURY M
11INE VIEW CEMETERY
R
U11EMR 1 OR I UM
Quaker, llt)aii, laueeitsbury, New York 12804
Phone (518) Crematorium 745-4477 or if no answer
Cemetery 745-4476 ti
AU1'I IUR I ZnT I ON 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 :
NORA WEAST FEMALE
(Name) (Se►c)
RD ARGYLE, NY 12809
(Street ) (City) (State) (Zip Code)
who died on 13TH day of NE 19 U _
at GLENS FALLS HOSPITAL
(Place) (flcidrPss )
Name and address of nearest living relative or name of person
authorizing cremations
TERRY SHERMAN, 1715 HUBBARD LANE, VINELAND, NJ 08360
(Name) (Addrous )
Relationship to the deceased NEPHEW
Name of Funeral Home M. B . Kilmer Funeral Home
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or
has no pacemaker in his or tier 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 them by
reason of or connected with the cremation of said remains as
directed, whether such claims or demands are or are not wholly
groundless, false or Fraudulent.
�-Hess ) tAddress )
(Sign ture of Relative or egal Rep. and Address)
Signed on this date : 6/14/97