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Spaulding, Forrest 2O Y YN OF QUEEVBU—'R...Y PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director C: IA (-LQTon) Name r 2 cj�� A(/ i rvC a s e #i ga Date of Crematicn I / Time Cremation Started 710 ,. 50 a . m � Time Cremation Completed A , M , Type of Container 0- IL"ra eb l`z &I C-0-S� Remarks : /��Ai N ,�3tJ/r��R o.�r �l •S S A�m 416 l © ; SS , n-,, : lSp , gi i i D I SPOS I T I ON OF ;CREMAtED nF.Mn I NS I hereby direct Pine View Crematorium to dispose of the cremated remains as follows : Mail to Other arrangements - please specify ;Funeral Home Will Pick Them Up . If pulverization of cremate remains is requested, check here POLICIES, RULES AND REGULATIONS 1. The crematorium will be open for cremations 5 days a week 7:00 R. M. - 3:30 P. M. Monday-Friday. No Holidays or Sundays, arrangements can be made for Saturday. Prearrangements by 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 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 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 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 or demands are, or are not wholly groundless, false or fraudulent. This authorization in addition to a regular burial permit must accompany the remains. 4. Ail remains 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 bt answered on the authorization to cremate form before the remains will be accepted. 6. Unless other arrangements are made the cremated remains will be mailed via Registered U. S. Mail within three days .of cremation to the funeral home handling the service. There will be a $20. 00 charge for this service. Cremation; Administration Costs and Recording Fee: Adult $ 175. 00 Children (age 13 months to i2 years) $ 100. 00 Infants ( stillborn to 12 months) $60. 00 TOWN OF OUEENSHURY PINE VIEW CEMETERY a CREMATORIUM Quaker Road, Queensbury, New York 12804 Phone (518) Crematorium 745-4477 or if no answer Cemetery 745-4476 AUTHORIZATION TO CREM/1TE The undersigned requests and authorizes Pine View Crematorium, in accordance with and subject to its Rules and Regulations to cremate the remains of : Forrest J . Spaulding Male (Name) (Sex) Ingersoll Memorial Home , Schenectady, NY (Street ) (City) (State) (Zip Code) who died on Saturday day of July 19th 1997 at Ingersoll Memorial Home , Schenectady, NY (Place) (Address) Name and address of nearest living relative or name of person authorizing cremation : Alfred Dashnaw 3 Marine Dr . , South Glens Falls , NY 12803 (Name) (Address) Relationship to the deceased Nephew Name of Funeral Home Carleton Funeral Home , Inc . IMPORTANT: I reFsent that to the best of my knowledge, the deceased has or has 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 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, a se or fraudulent. C . Bruce Wetmore 68 6�6 Main St . , Hudson Falls , NY 12839 (Witness ) (Address) ( ignature of elative Legal Re and Address) Signed on this date :