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Burch, Albert 70 WN OF QUEEN4.5BU_'kY PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY. NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director ///�` �1/J/ ��� � MA /f Name &LE / &fc6 Case # /`5 Date of Crematicn � _/3 f Time Cremation Started bib Time Cremation Completed t bZt�11.�_ Type of Container /r d/��/7/[ J/ r �• � Q� �/y�.Y/�� Remarks : Ale2 N ',20 191 M Me- TOWN OF QUEENSBURY PINE VIEW CEMETERY & CREMATORIUM Quaker Road, Queensbury, New York 12804 Phone (518) Crematorium 774-44776or if no answer Cemetery AUTHORIZATION 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: Albert J. Burch Male (Sex) (Name) P.O. Box 884, Bolton Landing, N.Y. 12814 (Street) (City) (State) (Zip Code) who died on 9 Th day of March 19 98 at Glens Falls Hospital, 102 Park St. , Glens Falls, N.Y. 12801 (Place) (Address) Name and address of nearest living relative or name of person authorizing cremation: Mildred Burch, P.O. Box 884, Bolton Landing, N.Y. 12814 (Name) (Address) Relationship to the deceased Wife Name of Funeral Home Alexander-Baker Funeral Home, IMPORTANT: knowledge, the deceasedK� I represent that to the best of my (Circle One) has no pacemaker in his or her body. I certify that I have the full power and authorization to arrange for the cremation of the remains nd to direct the possessionsshavete�ther of the cremated remains, that any personal and a ree to protect, defend been removed or may be destroyed, 9 and save harmless Pine View Crematorium from any and all claims and demands for loss or damages which may be made against them by of said remains as reason of or connected with the cremation directed, whether such claims or demands are or are not wholly groundless f 11ke or fraudulent. '41 --5048 State Rt. 9, Chestertown, N.Y. 12817 (Witness) (Address) r ) P.O. Box 884, Bolton Landing,N.Y. 12814 (Signature of Relative or GLegal Rep. and Address) Signed on this date: DISPOSITION OF CREMATED REMAINS I hereby direct Pine View Crematorium to dispose of the cremated remains as follows : Mail to Other arrangements - please specify: 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 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 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 . 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 $195 .00 Children (age 13 months to 12 years ) $115 .00 Infants (stillborn to 12 months) $75 . 00 * Additional $50 . 00 charge for cremations done after 3 :00 P.M. Monday through Friday. Cremations done on Saturdays will be charged the additional $50. 00 .