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Woodruff, Guy TOWN OF Q,21EE 5BURY PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director 4f// /1 kk !U z Name 6�1)Y Owi), EE Case # Date of Cremation Z Time Cremation Started Z6 i 1n / (y l � Time Cremation Completed Type of Container Remarks : / f ©5'/91 l� 11 M ; Sr 19 1V1 TOWN OF OUEENSPURY PINE VIEW CEMETERY a CREMATORIUM Quaker Road, Queensbury, New York 12804 Phone (518) Crematorium 745-4477 or if no answer Cemetery 745-4476 f1UT1-IURIZATION TO CREMt1TE The undersigned requests and authorizes Pine View Crematorium, in accordance with and subject to its Rules and Regulations to cremate the remains of: Guy Lewis Woodruff _Male (Name) (Sex) 6 Paris Ave . , Hudson Falls , NY 12839 (Street ) (City) (State) ( Zip Code ) who died on Nov . 3 , 1997 day of 19 at 6 Paris Ave , Hudson Falls NY 12839 (Place) (Address) Name and address of nearest living relative or name of person authorizing cremation : Mrs June Woodruff , 6 Paris Ave . , Hudson Falls NY (Name) (Address) Relationship to the deceased Wife Name of Funeral Home Carleton Funeral Home , Inc . IMPURIANT: I re esent that to the best of my knowledge, the deceased has or h no 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 group less, fa ge or --raudulent. C . Bruce Wetmore 68 Main St . , Hudson Falls , NY 12839 Witness) (Address) (Signature of Relati a or Legal Rep. and Address) Signed on this date : Nov . 4 , 1997 DISPOSITION OF CREMAIED RFMf1INS I hereby direct Pine View Crematorium to dispose of the cremated remains as follows : Mail to Other arrangements - please specify : __Ca_rleton Funeral Home will pick them up . If pulverization of cremate remains is requested, check here_ POLICIES, RULES FEND RF_6ULAT I ONS 1. The crematorium will be open for cremations 5 days a week 7 :00 A. 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 Ccmetery, Quaker Road, Town of OURPnsbury. 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 ,grange 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 fraudl_rlent. This authorization in addition to a regular burial permit must accompany the remains. 4. All 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 be 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 1 .3 months to 12 years ) $ 100. 00 Infants ( stillborn to 12 months ) 060. 00