Antonetti, Mabel LO i' YN OF QUEEVBU9�Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director /(0-4 rEA( /V 6, �1.F1v1l�G
Name W bE/ N-�w' F�T!' Case #
Date of Cremation
A � r
Time Cremation Started
Time Cremation Completed 11.6 t 'l ,
Type of ContainerC X�xc- e2t= T
Remarks :
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AUTHOMI iArIGN TO Ci+tlkATL
The vndllrrigned rou"osts and authorlios Pine vl*w t"ROtgriuml In
at?eordance with and •uq.feelt to it$ mutes and Reaulattans to
ar$$st• tha r•eRnt l ms of l
.rY ibelia Anton aGi1........,y��.•.r .r.r�.....n rM.'.._ r.rwlW� w��� .qr.. r•rw .. n, .++wwwrr+/
(Nana)� • 13e
9990 mer Y ,iQuQ �lgpa lfsgtiR• ICY.
___ -,r•r....w••.wr ,Nw....•s.MIAYMr�.�w.. •.,.r/M .•......ter wr_
tdbreetl tCity) tat
ttsp t~ode)
wh* died al, 3 , __ -dw of .•„ �.Y...... ..,.. lt9a
at Ktlr� ram, e�Dur,$„ Co.-#idWia,LA+ kL. .w... •.._.� .... ... _
tplacay (Adaress) .....-__....�..
Niles •nd Sddreir. 4f nearstt living ralativs or raise of OersOn
avthertain# cr�rMaCigr :
Chadds Aat:vnabt i q � If � � .� � _w
Most) lAddreIs)
A0111t {0n sh i p to thw geeaased�man
Nast of Runaral Ham*,_ Xer-westerlund EiMminj Fvnvra3 Homo
Y nlanN�rlgl�l•r�
reernb that to the best bf ry knoNtrtlde, th* detrestst#d hbe or&VWf* t+ panels Age In his ar her irady, tCirc1e C?l'+rI)
I certify that t ?Nook bhe full powrr allQ *Wtherigetlem tb bMl'an�e
for the "aoatian Cf the remains and to dtredt thr dispositlCM of
the Rrematad rvooinso that any berse�al posteesslons have *fithr�
dberi F"Qnavwd er msy be dootrayad� 01, b#pQs to r
*!►d• 66Ya harrrlelrts otlna view Cryedl 01 uw fro$ •t D et#ctt defend
and drMarids for iofs qr d�low cp patch " r and all claisit
10e660n of or oennet;tea with y be etade against them br
dSroOtR,itf whether the ff""t '0" b# said remains a••weh Claia's or dalsandi • ire pr•
vrqundlfss� fp1se ar f�rawdulatib. ass net wholly
Thoms• R. Lloyd 39 High St. ttlobaro .'101
��I d d _•..�_.,,. .,.,
R9ionalur. et Ralativd ar �.• ai'A; _.
1�0 P• •rid Address) -,
#i#nad era t;r+ I r. U.ikrl_ ;u.. � �r�p
I lner%by dir oCt pine view Crematorium to COI SPOSQ Of :he CrgmatQ''
remains as Follows % `
flail to Ker-Westerlund Fleming Funeral Home, 39 High Street
Brattleboro, VT. 05301
Otne�^ arrangNmants please spar. ► fY � _..;......,._.�..:�.. ,_..��W.......��_.. ._
If Pulverization of' cremste remains is requested, check here
POLICIES, RULES RND R GUL IA T I C)N5
1. The ar•omatorium w; l 1 be open For• C;rtmat Ions 5 days a week
7t0f4 A. M. - 3zaa D. M. Monday-Friday, No Holidays or Sunday-),
arrangements C;an be made for Saturday. Prearrangements by
telephahe fOv- accvptanee of r'eRaln* i3 necessary.
2. pine Vies•+ Crematorium is locatwd on the grounds of the Dint
View Cearetpry, Quaker Road, Town of Qusensbury.
.3. An *uthgeltrtlutl fnr cremation Properly stgnitd by the nearest
next of kin or other authorized per•Sort stating that they do have
the power and authority to arrange for the Cremation of the
reffiains and to direct the disposition of the creriattd remains,
that any Pee'sandl ROssessiohs have ei�.Tter been removed or may be
destroyed and agree to prottctj defend ant save harmless Dina
View Crematorium from any and all clm &ms 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 sand
remains as directed, whether sueh claims or demands are, Or are
not wholly groundletis, false or fraudulent. This authorltation
in addition to a regular burial permst must aCce+spany tr,e
remains,,
4. Al remains must be enCased in a Caslyet Cr suitable alternate COAtai Mer. Caskets mat tr. ial. Na +tyra�'oaa and containers, er•yst be of combust bl r
Or plastic Containers will be scCs•pted.
'S. The yuestlon relWtivr to Cardiac pacemakers must be ahswtrec
accepted.
On the authirization to cremate farm nefp.-e the remains will bar
Br. Uniss* other arrangement% ar-s> ,*We tlse cremated remains w. j bt s!biled via R49, 9tered U. S. Miill . with,in three Coy, of cremation
to the funeral �inme' handling the service.ChargeThere will be s i2Q►, �Q+for t•r„ s Ker-v jCq.
Crematiun, i;hrn3ns5tratinn Costs iind t�vra.•,�i ��g Fve: Aault f175rb0
Children (age 13 months to 12 years) 41ab0. 00
to 12 Infants
(sEiilborr
aonths ) s60. 00
1 S: Pfdq L�Ek_'•?��'}-•'1��y Q T DL-7 i*:T (.1 t ITER