Batkay, Marilyn rrO%N OF QUEEVBU9KY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director �,�.
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Name M k ArAA— YCase #
Date of Cremation
Time Cremation Started A^
Time Cremation Completed l� M 1 `
Type of Container a&?Edd�/�J�
Remarks :
I
TOWN OF GUEENSBURY
pINE VIEW CEMETERY
A
CREMATORIUM
Quaker Road, Queensbury, New Mork 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:
Marilyn Batkay Female
(Name) (Sex)
Shine Hill Rd.
Hartford NY 12838
(Street ) (City) (State) (Zip Code)
who died on 18th day of April 2000
at Glens Falls Hospital
(Place) (Address)
Name and address of nearest living relative or nam4f-1Wf person
authorizing cremation: ,I .'Er
William Batkay 70 Mountain Rd. Gansevoort, NY 12831'
(Name) (Address) ,.
'
Relationship to the deceased son ,,_ ...
Name of Funeral Home
M. B. Kilmer Funeral Home
I NMRTANT
I represent that to the best of my knowledge, the dedeased has or
has no pacemaker in his or her body. (Circle.:On.e)
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 crematkon of said remains as
directed, whether such claims or demands are or are not wholly
roundless, false or fraudulent.
g
(Witness) (Address)
(Signature of Relative or Legal Rep. and Address)
Signed on this date :
R
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.
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5. The que-tion relative to cardiac pacemakers must be answered on
the authorization to cremate form before the remains will be
o-ocepted.
y e:
Unless other arrangements are made the cremated remains will be
smiled via Registered U.S. Mail within three days of cremation to
-he funeral home handling the service. There will be a $20.00
charge for this service.
Cremation, Administration Costs and Recording Fee: Adult $195 .00
►��n . � hil e s(a 13months to 12 years ) $115 . 00 Infants (stillborn to Q0
* 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.