Bedell. Grace TOWN OF QUEEVBU-1ky
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director 1016
Name /_Y 2 Case #
Date of Crematicn
i
Time Cremation Started /Q b
� t ,,Q e1
Time Cremation Compl et ed QU 3�// r Ki
Type of Container &1,AR.0 7.6X/1_.(/ / ,�/i G'/�✓ o TJj�it��j�j�
Remarks :
,411q/ IN /l"le /51/N1 l
j
i /M )
11 Il�r 7/&l ''
DISPOSI`L'ION OF CREMATED REMAINS ,
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mail to is. 39.
17 8aranaa Ave,
E*A* Placid, N'Y, I.EF4f
Other arrangement - please specify:
If pulverization of cremated remains is requested, check here
POLICIES, RULES AND REGULATIONS
I. 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 Cemetery, Quaker
Road, Town of Rueensbury.
3. An authorization for cremation properly signed by the nearest next to 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. 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 $10.00 charge for this service.
Cremation, Administration Costs and Recording Fee:
Adult $140.00
Children (age 13 months to 12 years) $90.00
Infants (stillborn to 12 months) $50.00
ADDITIONAL SERVICE
Storage of cremated remains - per month $2.00
�s
TOWN OF RUEENSBURY
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road, Rueensbury, New York 12804
Phone (518) Crematorium 798-4726 or if no answer Cemetery 793-9777
AUTHORIZATION TO CREMATE
,-he undersigned requests and authorizes Pine View Crematorium, in accordance with and
subject to its Rules and Regulations to cremate the remains of:
GRACE T. BEDELL
Name FEMALE
Sex
Street 420 Old Military Road , Lake Placid , NY 12946
City State Zip Code
vho died on 31st December day of 19 97
it Adr 'k Medical Centre , Saranac Lake , NY
Place Address
Tame and address of nearest living relative or name of person authorizing cremation:
Barbara T. Kelly , 46 Forest St . , Lake Placid , NY 12946
Name Address
'.elationship to the deceased Daughter
ame of the funeral home 87 Saranac Ave.
Lit! P1w.,tw �v t 9au
4PORTANT:
represent that to the best of my knowledge, the deceased has or-has_uo pacemaker in his
her body. (CIRCLE ONE)
2ertify that I have the full power and authorization to arrange for the cremation of the
mains and to direct the disposition of the cremated remains, that any personal possessions
ive either been removed or may be destroyed, and agree to protect, defend and save harmless
ne View Crematorium, from any and all claims and demands for loss or damages which
ay be made against them by reason of, or connected with the cremation of said remains
directed, whether such claims or demands are, or are not, wholly groundless, false or fraudulent.
Wit Aes (Signature of Relative r Legal Rep.
46 Sentinel Rd .
Lake Placid , N8artnacAve. Y 12946
Address Lake Placid, -N.Y. Address
;ned on this date