Morgan, John �o WN of QUEEVBU-WY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director /�/
Name Ls /y hl: /11&4x Case # � /f
Date of Crematicn ,
Time Cremation Started /&—o lm
Time Cremation Completedd 1k4d At w
Type of Container
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TOWN OF DUEENSBURY
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road, Queens.bury, New York 12804
Phone (518) Crematorium 745-4477 or if no answer
Cemetery 745-4476
AUTHORIZ�kTION 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:
John R. Morgan Male
(Name) (Sex)
Broadway, Fonda, NY 12068
(Street ) (City) (State) ( Zip Code)
who died on 18th day of March 19 98
at . 215 Montgomery St. , Johnstown, NY 12095
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation :
Glenn F. Baker_ 11 Warren Street _ Warrensburg, NY 12885
(Name) (Address)
Relationship to the deceased Grandfather
Name of Funeral H o m e Alexander-Baker FH, Warrensburg, NY
IMPORTANT:
I represent that to the best of ray knowledge, the deceased 7500DUff
has no pacemaker in his or her body. (Circ`le 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-ior are—not wholly
gro-,.nd-1 s, false or fraudulent.
Warrensburg, NY
( itness) (Address)
Same as above
tSignature of Relative or Legal Rep. and Address)
Signed on this date : 3-19-98
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 tre
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 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 answe*-et
on the authorization to cremate form before the remains will be
accepted.
6. Unless other arrangements are made the cremat-ed remains w1 ; :
be mailed via Registered U. S. Mail within three days of crematio7
to the funeral home han.dl ing the service. ' '`fhere will be a $20. 00
charge for this service.
Cremation, Administration Costs and Recording Fee : Adult $ 175. 0
Children (age 13 months to 12 years ) $ 100. 00 Infants ( stilibc
to 12 months ) $60. 00