Abare, Agnes rrnTI)N OF QUEENs5BU9ZY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director 'TE "AE2f
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Date of Cremation gn=
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Time Cremation Started /,CJ,//M i
Time Cremation Completed 4
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TOWN OF QUEENSBURY
PINE VIEW CEMETERY /
CREMATORIUM JlCJL1
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:
Agnes Abare Female
(NAME) (SEX)
_ P.O. Box 130, Winebrook Hills, Newcomb, N.Y. 12852
(STREET) (CITY) (STATE) (ZIP CODE)
who died on 21 St. day of April 2d)0
at Glens Falls Hospital, 120 Park St. , Glens Falls, N.Y. 12801
(PLACE) (ADDRESS)
Name and address of nearest living relative or name of person authorizing cremation:
Leonard Abare. P.O. Box 130 Winebrook Hills, Newcomb, N.Y. 12852
Relationship to deceased Husband
Name of Funeral Home Alexander Funeral Home, Rt. 28, North River, N.Y. 12856
IMPORTANT
I represent that to the best of my knowledge, the deceased JgUM 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 groundless, false or fraudulent.
hIF7. 8 State Rt. 9 Chestertown., N.Y. 12817
(WITN ) (ADDRESS)
(SIGNATURE OF RELATIVE OR LEGAL REP. AND ADDRESS)
Signed on this date: April 24, 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 crerated 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
i -----fet sins-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
fYY o harmless Pine View Crematorium from any and all claims and demands for loss or damages
:li'..YLA;'r .
which maybe 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
ab a alternate container. Caskets and
__ _motainers 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
pn_ - b a $20.00 charge for this service.
Cr3mation, 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.