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Prime, Cynthia �o WN OF QUEEVBURY PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director ON A&-15;1 NameXN 7-b'd / ,- Case # zQ Date of Cremation c2 E Time Cremation Started Time Cremation Completed ,��Q'9 �; �f Type of Containers/�jli�j�/fj�jY� i�1(�oLNDrG/ D� 7-��Ji9y Remarks : /.` TOWN OF QUEENSBURY PINE VIEW CEMETERY CREMATORIUM Quaker Road, Queensbury, New York 12804 Phone (518) Crematorium 745-4477 (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: Cynthia S. Prime Female (NAME) (SEX) 5 Cottage Street Greenwich New York 12834 (STREET) (CITY) (STATE) (ZIP CODE) who died on 5th day of February 20 0D at residence 5 Cottage Street Greenwich, NY 3.2834 ;;. , L (PLACE) (ADDRESS) Name and address of nearest living relative or name of person authorizing"&61i4tfoi!,' Roger Prime 5 Cottage Street Greenwich:,:1�Y,i�7172934 ,nn e;F 17 lj Relationship to deceased Husband Name of Funeral Home Flynn Bros. , Inc. IMPORTANT I represent that to the best of my knowledge, the deceased has or has no pacematCtr-ln hjs off==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 ason of or connectpd with the cremation of said remains as directed, whether �- - claims o ,ma ar r wholly groundless, false or fraudulent. 80 Main Street Greenwich NY 12834 I N S) (ADDRESS) 5 ttage Street Greenwich, NY 12834 (SIGWATURE 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 XX 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 _ __ 0-"h!1elephQne for acceptance of remains is necessary.* 2. Pine View Crematorium is located on the grounds of the Pine View Cemetery, Quaker Road, Tobtn Qf Q.ueensbury. 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%ar d 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 ----liarmlp.ss 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 and/or disposition of said remains as directed, whether such claims or demands are, ---- __.mace-nod._whrl ygr_oundless, 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 Styrofoam 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$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. 70 WN OF QUEEVBU9ZY PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director �,yj�/� NameGy,� �/�i /�iM,� Case # �Q Date of Cremation c2— p7QG E Time Cremation Started I Time Cremation Completed /—<& 9 0iN11 Type of Container�/�if�/�j�� n/��/l��./ �7C Remarks : I TOWN OF QUEENSBURY . PINE VIEW CEMETERY CREMATORIUM 40 Quaker Road, Queensbury, New York 12804 Phone (518) Crematorium 745-4477 (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: Cynthia S. Prime Female (NAME) (SEX) 5 Cottage Street Greenwich New York 12834 (STREET) (CITY) (STATE) (ZIP CODE) who died on 5th day of February " 20 00 at residence 5 Cottage Street Greenwich, NY 3.283&,)` .J', ., i, (PLACE) (ADDRESS) ' _ ..is fl• ��.VI1f J'� Name and address of nearest living relative or name of person authorizing"creiii4tiioti;ry'Sf Roger Prime 5 Cottage Street Greenwich,,.sXYiJ28-34 On 5';E1711"; Relationship to deceased Husband Name of Funeral Home Flynn Bros. , Inc. IMPORTANT I represent that to the best of my knowledge, the deceased has or has no pacdmatC�r in hjs o 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 eithet 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 byzFeason of or connectpd with the cremation of said remains as directed, whether claims o ma ar r wholly groundless, false or fraudulent. 80 Main Street Greenwich, NY 12834 I N S) (ADDRESS) 5 ttage Street Greenwich, NY 12834 (SIG TURE 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 j= .Other arrangements-please specify: Will Pick Up If pulverization of cremated remains is requested, check here XX 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 _,_0 b _1elephQne for acceptance of remains is necessary.* 2. Pine View Crematorium is located on the grounds of the Pine View Cemetery, Quaker Road, ..._-.W__.._I.om n..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 remaih87arfd 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 __-__.__b.armless..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 and/or disposition of said remains as directed, whether such claims or demands are, —._..___.nr are-riol_whcLU r.groundless, false or fraudulent. This authorization in addition to a regular burial permit must accompany the remains. a AU,remains.must be encased in a casket or suitable alternate container. Caskets and containers must be of combustible material. No Styrofoam 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$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.