Wagener, Joan r'O l+N OF QUEEVBU9ZY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director,B()g 1.�-4
Name �EA/V tj&1-6� Case # �g
Date of Cremation.Z— ! g`ad
Time Cremation Started �� /�//� T
Time Cremation Completed /Orl q�f7AM
Type of Container G-/RP4( �" ,D
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TOWN OF QUEENSBURY
PINE VIEW CEMETERY
!L
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. Cre:matorium, in
accordance with and subject to its Rules and Regulations to
cremate the remains of:
Joan Waggner Females
(Name) (Sex)
156 Lawrence St. , Apt 313, Saratoga Springs, NY 12866
(Street ) (City) (State) (Zip Code )
who died on 15th day of January X1 ( 2000
at_156 Lawrence St. , Saratoga Springs, NY 12866
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation:
_ Mr. Richard P. Wagener, 3101 Delano Rd. , Oxford, MI 48371
(Name) (Address)
Relationship to the deceased SON
Name of Funeral Home William J. Burke & Sons Funeral Home
IMPORTANT:
I represent that to the bar f my knowledge, the deceased has or
has 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 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 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
gro ess, false or f audulent.
J � 628 N. Broadway, Saratoga Springs, NY
( 7ss
(Address)� �101 Delano Rd. , Oxford, MI 4$371
(Signature of Relative or Legal Rep. and Address)
Signed on this date : January 16, 2000
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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 hare
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
telephdh-d`for acceptance of remains is necessary. *
2 . ___Pine View Crematorium is located on the grounds of the Pine
View C�mt6,ry; Quaker Road, Town of QueensiDury.
3_._--An?luthorization for cremation properly signed by the nearest
next of kin or-other authorized person stating that they do have
tlie-.pomex�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
a?1rkry!%gre,e, ,ta; 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, whetfier s"uCh claims or demands are, or are not wholly
groundless, false or fraudulent. This authorization in addition to
a rtgjklar burial permit must accompany the remains .
a . All , remains must be encased in a casket or suitable alternate
container. Caskets`afTd-containers must be of combustible material .
No styrafoam or plastic containers will be accepted.
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5 . The question relative,to cardiac pacemakers must be answered on
the authorization to cremate form before the remains will be
'flame' ;:ed.
Unless other arrangements are made the cremated remains will be
''Fa'i`led via Registered U.S. Mail within three days of cremation to
rr r:e funeral home handling the service. There will be a $20 . 00
fJ`ciarge 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 .