Izzo, Mary rl-O WN OF QUEEVBURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director /—'/,Y/j�/�(
Name Case # '�
Date of Cremation ` q
Time Cremation Started
Time Cremation Completed t1ts—&M %
Type of Container
Remarks :
7;(C ,,9.m
r n
r
i
i
TOWN OF QUEENSBURY _
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road, Queensbury, New York 12804 /
Phone (518) Crematorium 745-4477 (if no answer) 6
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:
Mary J, Izzo Female
(NAME) (SEX)
21 Safford Hill Road Greenwich, NY 12834
(STREET) (CITY) (STATE) (ZIP CODE)':
who died on 6th day of February 2000
at
McClellan Health Sysytems Hospital Cambridge, ;.NY _ 1
(PLACE) (ADDRESS)
Name and address of nearest living relative or name of person authorizing:cremation:,r,I S
William Nolan 21 Safford Hill Road Greenwic 1'L,NY 12834
Relationship to deceased Companion
av&f
Name of Funeral Home Flynn Bros. , Inc. - Greq�nwieh,,;;NY,-,.,
IMPORTANT
I represent that to the best of my knowledge, the deceased has-or'pOea .,gkqg-!iMAis W 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 hay"*ther#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 clai 'r d are not wholly groundless, false or fraudulent.
80 Main Street Greenwich, NY 12834
W NESS) (ADDRESS)
21 Safford Hill Road Greenwich, NY 12834
(SIGNATURE OF RELATIVE OR LEGAL REP. AND ADDRESS)
Signed on this date: Feb. 6, 2000
DISPOSITION OF CREMATED REMAINS
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mail to
Other arrangements-please specify: Will Pick Up
if pulverization of cremated remains is requested, check here X
------- 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,._ P_jn6 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
aoawmains 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 a`nd_T6 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
"-''crmtainerrrcast be of combustible material. No Styrofoam or plastic containers will be
r accepted.
the question relative to..'ardiac pacemakers must be answered on the authorization to
cremate form before'tfie`remains will be accepted.
.,
t9nless dth`er arrangements'are made the cremated remains will be mailed via Registered
t9S. Mail within three days of cremation to the funeral home handling the service. There will
be a$20.00 charge for this service.
C7remation, Administration Costs and Recording Fee: Adult$225.00 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.