Schmoler, Kenneth T07+N F QUEEN
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PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name r=(\) tk � l K 'R 6c, ioo�c-la`'Z # cz /
Date of Cremat i cn
Time Cremation Started
Time Cremation Completed Type of Container 6 1t jz--) 13 d ifs- r,0!`� I �- �� wd '�
Remarks :
1� 11
TOWN OF pUEENSHURY
PINE VIEW CEMETERY
I4
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 745-4477 or if no answer
Cemetery 745-4476
AUTHORIZATION TO CREMATE
The undersigned requests and authorizes Pine View Crematorium, in
accordance with and subject to its Rules and Regulations to
cremate the remains of:
LIV (Sam)
(Name)
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(State) (Zip Code)
(Street ) �NO (City)
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who died on � day o f IIJ� 19
at
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(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation:
40
(Name) (Address)
Relationship to the decease
TO
Name of Funeral Home
IMPORTANT: knowledge, the deceased has or
I r t that to the best of my 9 +
as no pacemaker) in his or her body. (Circle One)
I certify that I have the full power and authorization to arrange
for the cremation of the remains ersonal direct
possessions disposition
either
the cremated remains, that any p
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 or damages which may be made against them by
reason of or connected with the cremation of said remains as
directed, whether such claims or demands are or are not wholly
groundless, false or fraudulent.
(Witness) (Address)
0,01
,fD.
(Signature of Relative or Lega Rep. and Address)
Signed on this date:
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 .
06/03/1999 13:32 315-735-5859 DRAKE AND DRAKE PAGE 02
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DRAKE & DRAKE
COUNSELORS AT 1.AW
1416 IDENESEE STRUT i
t1TICA.FXW YORK 1054DO
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FACSIMILE NO.Ors-ais•swsa
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:Ilnill F;.F; I1H.5k1' June 3, 1999 'dUHI.XS A.UNARB u'.no-l4wl
!1}tANUN uVYti;H'
INI.Fa' W.Y.
It-nr.r.u111
Brewer Funeral Home,Inc.
P.O. Box 500
Lake Luzerne,NY 12846
VIA MAIL&FACSIMILIE#(518)696-2743
i
RE: KENNETH SCHIMOLER
Attn: Craig Reukauf
Dear Mr. Reukauf:
i
This letter is to advise you that I am the attorney for Gordon. M. Ellis. Kenneth
Schimoler was found dead in his home on June 2, 1999.
Kenneth Schimoler had prepared his own Will and had it witnessed by two (2)
local Indian Lake residents. l have not personally seen the document. However, the
document was read to nae and in my opinion, it is a valid Will.
The Will names Gordon M. Ellis as Executor and he is also a primary beneficiary.
I had prepared a Will for Kenneth Schimoler in 1973. To the best of my '
knowledge,he has no close living relatives.
In my opinion, Gordon M. Ellis has authority to make arrangements for the
cremation of the body.
Very truly yours,
CHARLES E. DRAKE
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