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Celeste, Marty T- O74N OF QUEEVBU-Ry PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY. NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director 6I�Rkg 7e- Name ase # Date of Cremation < a Time Cremation Started Time Cremation Completed 9C06 Type of Container Remarks : Al / N ,r3y�i��R o� �-r© �/��M ' A16 zl�F-p 7;a 9 "M :ell fm i TOWN Or- QUEENSHURY PINE VIER CEMETERY CREMATORIUM Quaker Road, Queensbury, New York 12904 Phone (518) Crematorium 745-4477 or if no answer Cemetery 745-4476 nUT1-IORI ZAT ION TO CREmnTE The unddrsigned requests and authorizes Pine View Crematorium, in accordance with and subject to its Rules and Regulations to cremate the remains of: Martin Bruce Celeste Male (Name) (Sex) Valley View Road, Twn of Argyle , NY 12809 (Street ) (City) (State) (Zip Code) who died on Jan. 19 , 1998 day of 19 at Valley View Road, Twn of Argyle , NY (Place) (Address) Name and address of nearest living relative or name of person authorizing cremation : Ms . Mindy Celeste , 14 Oak St . , Hudson Falls , NY 12839 (Name) (Address) Relationship to the deceased Daughter Name of Funeral Home Carleton Funeral Home , Inc . IMPORTANT: that to the best of my knowledge, the deceased has or I represent as n acematter 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 groun less, false or__.fraudulent . 68 Main ST . C . Bruce Wetmore Hudson Falls , NY (Address) ress) ignatu a of Relative or Legal Rep. and Address) Signed on this date : January 23 , 1998 DISPOSITION OF CREMnTEP RV-MnINS I hereby direct Pine View Crematorium to dispose of the cremated remains as follows : Mail to Hold for Carleton Funeral Home to pick up . Other arrangements - please If pulverization of cremate remains is requested, check here XX POLICIES, RULES nND REGULATIONS 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 Cemetery, Quaker Road, Tovin 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 mny 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 frauriulent . This authorization in addition to a regular burial permit must accompany the remains. 4. All remains must be encased in a castcet or suitable alternate container. Caskets and container-- must be of combustible material. No st,yrafoam 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 s20. 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) $60. 00