Witting,Elizabeth • uYJdLaL_C. .........
709+N OF QUEEVBU9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY. NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Directork1� /
Name /�1 �1��// > �L_Case #
Date of Crematicn 'B `/3
Time Cremation Started /1�3 )21/► :
Time Cremation Completed � � � � iAI
Type of Container �( )�/% (' � JAP,
Remarks :
_ - - Vermont Cremation Service
Box 957
213 West Main Street
Bennington, Vermont 05201
(802)442-9585 or in Vermont 1-800-244-9585
CREMATION AUTHORIZATION
STATE Vermont Cremation Number
COUNTY OF Bennington Cremation Date
(for cremation use only)
IDENTIFICATION
The undersigned authorizes Vermont Cremation Service ("Crematory"), in accordance with and subject to its Rules and
Regulations, and any applicable federal, state and/or local laws or regulations to cremate
Elizabeth Witting who died at Manchester on the 12th
day of October 19_ 88 at the age 91_ years and agrees to be responsible for and pay all charges
incurred with respect to this authorization.
The Funeral Director in Charge is Matthew Waller (Funeral Director). I Further state the death ❑ was
111 was not due to infectious or contagious disease. I understand that if I do not notify the Crematory about a death by
infectious disease, that I will be liable for any damages to the Crematory or injury to Crematory personnel.
As the authorizing agent for the cremation of said deceased Elizabeth Witting I have 41 identified
❑ authorized (as my agent to identify) the deceased as Elizabeth Wi tti ng . I hereby
certify that I am related to the deceased as Son , or otherwise serve in the capacity of
and that I have the right to authorize the cremation and disposition of the cremated person.
DISPOSITION j
It is requested that the following disposition be made of the person:
❑ Place the cremated person in Cemetery-fees furnished upon request.
❑ Delivery to Following cremation the undersigned hereby authorizes Crematory
to deliver Via Registered mail and agrees to assume all liability for any damages that may arise from any cause growing
out of said delivery and to indemnify and hold harmless the Crematory and the Funeral Director from any and all claims
related to said shipment.
To be called for by Brewster Funeral Service
I understand that due to the nature of the cremation process any valuable material, including dental gold, will either be
destroyed or not be recoverable. Any personal possessions accordingly have either been removed or may be destroyed. "if
the container or any other portion thereof is not suitable for cremation, Crematory may require the person be removed to
suitable container." I understand that cremated persons are bone fragments, which will be reduced in size and placed in an
urn. Urns provided by Crematory are sufficient in size for all cremated persons. In the event the capacity of the urn I select-
ed elsewhere is less than the amount of the cremated person, the Crematory is hereby authorized to return said excess of
the cremated person in a temporary container. I further agree that I will indemnify and hold harmless the Crematory and
Funeral director,their officers and employees from liability,costs, expenses, or claims from this authorization.
LIFE SUSTAINING DEVICES
I further state that the deceased has not had a heart pacemaker implanted, radiation producing implant device, nor any
other life sustaining device that could be explosive. If such a device exists, I have instructed the funeral director or others
to remove it before cremation. I also agree that in the event of my failure to notify the funeral director or any others
.,.,..., --;kl„ 4:- +&,- of el le-h Having i will ha lfahla for anv damages to the Crematory or iniury to the Crematory j