Tatro, Lorraine '17-0WN OF QUEEN4,5BUJ�Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director 1' ,,5X- AV—A7—
Name // r/T/C /tC� Case #
Date of Cremation&—x� —
Time Cremation Started Zo-7,r aC, /- i A4
Time Cremation Completed j
Type of Container
Remarks :
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Vermont Cremation Service
Box 957
213 West Main Street x
Bennington, Vermont 05201
(802) 442-9585 or in Vermont 1-800-244-9585
CREMATION AUTHORIZATION
STATE Cremation Number
COUNTY OF _ 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
Lorraine C. Tatro who died at North Adams. MA on the 12th
day of Oct. 19 98 at the age 62 years and agrees to be responsible for and pay all charges
incurred with respect to this authorization.
The Funeral Director in Charge is Robert W. Auge (Funeral Director). I Further state the death ❑ was
M 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 I have U identified
❑ authorized (as my agent to identify) the deceased as Lorraine Tatro . I hereby
certify that I am related to the deceased as Gi c;tpr I , or otherwise serve in the capacity of
and that I have the right to authorize tho cremation and disposition of the cremated person.
DISPOSITION
It is requested that the following disposition be made of the ,Jerson:
❑ Place the cremated person in Cemetery-fees furnished upon request.
W Delivery to Auge Funeral Home 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
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
responsible for the removal of such device, I will be liable for any damages to the Crematory or injury to the Crematory
ti
Certificate before Cremation,required by Revised Laws of Massachusetts,Chapter 78,Section 37.
COUNTY of BERKSHIRE
Benjamin Glick the duly appointed and qualified medical examiner for
the 1st district of said county of Berkshire hereby certify that I have viewed
the body of Lorraine C. Tatro who died at North Adams within said
district upon the 12th day Oct. 19 98 ; that I have made personal inquiry _
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into the cause and manner of h er death, and am of the opinion that no further examination or IJ
Judicial inquiry concerning the same is necessary.
Witness m hand this 13th day o Oct. Jg 98
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