Weinstein, Irving TOWN OF QUEEVBWAY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director 1'1�
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NEGRIN Fax:212-421-0524 Jul 25 '98 16:26 P.02
TOW OF GUIXNBM*v
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Gma4or Road, ameensbvey, New York 12904
phone (919) Cree/tOrivN 743-4417 or if na answer
Cemetery �4�-A476
IAUrHW1 ZATICW TO CREMATE
The undersigned requests Arid authors=es Dine win„ CrOOOteriue, in
oceordanee with and subject to its Rules and Regulations to
cremate the remains ft
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None and address of nearest living relative or name of person
authorizing A Ti pa, Oueensbury, No" York 12904
l/h L(r'Se (310)l--�t`l Orsmaem � �3-4477 or na answer
(Name)
tAOdress�
pUTHOPIZATIM TO CMMATE
W1400" View Crematorium, to
accordance with end subject to. its Rules And R02414tlofts to
A�tN tt�Mp+eM'dS iwea t a
i re00#tdnt that to the most of my k"IMI igd, the deceased has or
has --�P ri �Q or• �b d 'tf c4�ra ll04- e1 1 - � L
Y 4e140:frjet;tlat 1 have tJ1#C004y# power and9i0090 :af jiFhG 04irronge
for the Cre"ti h fie remains end to d' ct the dispesiti of
wsMe da1�r�'ed, ..,.� t w.t_„�yp ilfs aaws�dim
baanr
r or m - #"r3� 't .4 e t r feet, defend
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an/1 diod"d for lvss or cq `iJ+ieh Say be made a snst then by
reason of .or Connected vk4*° 04 1&eeatien Of said remains as
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•ignature of Rolative, or egal Rope and Address)
Naer of funeral W64e
Signer on this dates
OF
hear no paceaema a Lm rots or hor Oudy-
>[ eeoftfyost+at 1 mave . the�'�ful power and sut++ari:arltdn 'ti i -range
for the cremati_ 6f' l.he remains end to dirvc,t the disposttlkA, Gy
L#'"edaF444M.9 psoa� ..,<.• aa'saama ts+ws visr
boon,, ,r000*04 eft M,4 C�
dest�r.-.eTfd, . end ,spree. . to, i prtect, defend
_...b. c:i4— z. w r1 01At • Utarc 80 ��a^)LhuN fr0f.' +sr: ° g.ea .
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 .