Auerbach, Bernard TOWN OF QQUEENSBU92y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
NameCase #
Date of Cremation
Time Cremation Started
Time Cremation Completed ,
Type of Container
Remarks :
,41,41'lq a0yVA9-9 OX
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.
TOWN OF GUEENSDURY v
PINE VIEW CEMETERY
CREMATORIUM
Queensbury, New York 12804
Quaker Road,Phone (518) Crematorium 745-4477 or 1f no answer
Cemetery 745-4476
AUTHORIZATION TO CREMATE
i authorizes Pine View Crematorium, in
and au
The undersigned requests subject to its Rules and Regulations to
accordance with and
cremate the remains of:
Bernard t5ex)
(Name) 12831
Gansevoort, NY 32 Highgate Rd. , (State) (Zip Code)
(City) _
(Street ) 19 99
29th
day of March
who died on
at rings Way NursingCenter,
Schenecta d NY(Place) (Address)
Name
and address of nearest living relative or name of person
authorizing cremation:
Nancy i�ochheiser,
32 Hi h ate Rd. , Gansevoort NY 12831
(Name) (Address)
Relationship to the deceased
Daughter
Name of Funeral Home William J . Burke & Sons Funeral Home
IpPORTANT: a best of my knowledge, the deceased has or
I represent that to� tCircle One)
has no pacemaker in his or her body.
nd authorization to arrange
I certify
that I have the full power a
for the cremation of the remains nd to ldirect ssionsthe shaveteither
the cremated remains, that any p rotect, defend
been removed or may be destroyed, and agree to p
Cremat
any and al
and save harmless Pine View orium fgainstlthem1
ms
be m made a by
and demands for loss or damages which may 9
reason of or connected with the cremation of said remains as
directed, whether such claims or demands are or are not wholly
ro ndless, false or fraudulent.
r b28 N. B a S rin s NY 12866
(Wit ess) _ tAddress)
to P/S2 Highgate Rd. , Gansevoort, NY 12831
tSi nature of Relative or Legal Rep. and Address)
Signed on this date : �� 3� �9%y