Hall, Lorraine . rl-nWN OF QUEEN
,5BUJ�
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD. QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Names o/ /7!dk-- L Case # '< 17
Date of Cremation
Time Cremation Started ZY 2 .,M r
r
Time Cremation Comoleted � � IM I
T y p e o f C o n t a i n e r /e1(1ViC Gj9j��,�T 3�l,(fir G LC
Remarks : /
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19t, 34 P/M
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TO LU.RY;
OR M Quaker,.Road,;".I,: Os ury, New York 12804
t7(ifno-answer)
Cemet ry, 45=4476
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:AJTH RI ONTO CRw E,�IATE f
The undersigned requests` , .uthorizi3s:,Pns.Vi w Crematorium, in accordance with and subject
to its Rules and Regulation to 6rema Mai S:of
Lorraine A. Hall ,:.,.:;. ,•w :; 1' ;,r :.;x'.; ;.Fgpa.le.
(NAME) .:± (SEX)
25 oak St. , Warrensburg, Ny_J-288$
(STREET) �** = :,(CITY.)* : LL ;`: ,; (STATE) (ZIP CODE)
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who died on 12th' t.,wt; .. :tG :; ayN� Auk., ;,. 2001
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at
(PLACE) ADDR„ASS
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Name and-address of n.qareslJiving,,relsZiu@ior. al -otperson authorizing cremation:
Alan J. Hal .,:.�} 4ivh is
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.: .; . . ,.•_A• • art:f/♦y�q+� 72' ♦tn.``'_"x�..rN'/YS ,r.K, }}`��+ I:.'.;",n.. '1,:
... •_:. •,. ..• ,.'r �.,`�t/11'tt;�.�X7W.SJ ri•tisv.Y. ':$T( � iR�-i.'; ,
Relation. hip.to
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L.'� 'Gr�I'Yij •i+ .'. .•.
Name of Funeral Home Alexander. inc. , Warrensburg, NY
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IMPORTANT
I represent that toJhe b4ptlpfipy.,,}S wl a; ecgsse�has no pacemaker•;n his or her
body. (CIRCLE ONE) ` , : .4 a.r; :,mott rfi
I.cert�fy ti��i.�;ha�i '. e mati0, Qf:th�r..mains and
to direF tW�sQ =q e_:_ aye tither been
re
moved or ma a Pi b . ..d " v sla rml ne`View
Q.. a a ess
II
Crematorium frorr an• `arid y all iris"and n tar .s`for ,loss,pr amages which may be rn,,6 '
against them. y.. . sQn°pf=•„ e„otedu th, , remstioRl•pf said remains as dir,.ctec, whether
such c ims o a s'are a nptiwglly:.gondlessi-t'false.or fraudulent.
i
(WITNES )
Same as above
(SIGNAPgE OF REII IVF:OR LEGAL;REP. AND ADDRESS)
Signed on this date: 8-12-01
' I
' I
DISPWITI
IT.
law
I hereby direct Pine View.Ctdrr atbilbm,t4iij;Qsj f thei.cremated remains as follows:
Mail to
Other arrangements-please specify:
If pulverization of crematedrep gjs r q"0q,cheek he
re
P-OLS ko'U, AN
D DREOULATIONS
-, A
_.A. The crematorium will be open for cremations 5.days a week 7:00 A.M. -3:30 P.M. Monday-
Friday. No Holidays:.9�.,%4qd,1p, aqqpg6ments c _M_aqqfor.Saturday. Prearrangements
by telephone for acceptance of remains is necessary.*
2. Pine View Crematorium is lqqptpd on thegrou s_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'.d.o.,Iiivja,,the,,.power,,.anqL,,.authorityito arrange for the cremation of the
remains and to direct the disposition of the cremated remains, that any personal possessions
have either been removqqgWay _pjp 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 and/or disp4jk4pajoj,;said rg' "'' ` irected ether such claims or demands are
PPAP-W ,,.W h
or are not wholly groundless;-false or frouduleht. This authorization in addition to a regular
----burial permit must accompa hy the remains.
4. All remains must be encased in a casket,o*r suitable alternate container. Caskets and
containers must be of combustible material. No Styrofoam or plastic containers will be
)"_r$ "', accepted.
5. The quesbon relativetq:ca0c pac6mpors Must'b&answered on the authorization to
brisa" cremate form before the remains will66 accepted.
tJnless-otherarrangetTionti-.-�-ir th,a'-pre ate&remains will be mailed via Registered
#madW
U.S. MaI1,withIn'thrd6WW0,-?r5 ral: :handling the s'
Vpema00nX6.*iftne oh6me service. There will
he a,$26 00'chargeIork
Cremation, Administration'.UstCand Recording'Foe: Adult$225.00 Children (age 13 months to
4 12 years) $115.00..Infaft,(stillbo"rin'to lZimonthsy$75..'00
Additional $50.00 charge-fQr,.cr
through Friday.
Cremations done on Saturdays will be charged the"aidditionil$50.00.