Warrington, Douglas rl-
L O OF QUEEN5B .OKY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director � ��/�,�/�
Name , I vl�U�i� /T R�i ��(Case # crl�
Date of Cremation ,2c7e/
Time Cremation Started T �JS✓' )
Time Cremation Completed
IItm �
T y p e o f C o n t a i n e rW 1 L- ( 7-11 e)95A-,E_ T
Remarks : en, RD
TQ X.. S.BURY
P
CR " TORIUM`
t
Quaker Roade�rjsb4ry, New.York 12804
Phooa( l8);Cr #jf{�57,f(ifxno answer)
C..6 tery`745-4476
AUTHO `ZATION TO CREMATE
W.
The undersigned requests aljo authorize i eYisw Crematorium, in accordance with and subject
to its Rules and Regulations fo'cremate.1�emains`of
Douglas Warrington
(NAME) (SEX)
Peaceful Valley Road,-North Creek, New York 12853
(STREET) �{W". . .(CIT:Y�) `(STATE) (ZIP CODE)
the .22n ',",-
who died on ,,,3, r�:: ., y�o .., ctor' 2001
at His:"Home:.rQa-<'' Prr• J! ." ,�1•
(PLACE) (ADDRESS) x
Name and address of nearest living,relative'iorname;9fperson authorizing cremation:
LeMa Eoaty 53
: .. :, :. +.:-�i wt;L.,4'..F;Iti V 'eiTr'..F,�:v� Yi�t?�>!.'x7A�r''•"'..�;•t,'•;:'�' f -
Relationship.ta derease,Gl
• >. ;,�!'ra,"s.�{�.'�'-`A'**�F'�iri�r`:;!''';., '`i�;�;ra?�lt:'i�k'Stt�; �s':�`'• .. ,
Name of Funeral Home Alexander Pkneral Home, Inc. , North River, NY
F•, ;a•
.. _ <.;,;. .: .�r;i=3�+9�f ,�It��yyh'�si -i ��i'�>';+`�i5i;ti;<,^�:!j_•, .
IMPORTANT
I represent..that,.to tge,pe„stiploy�know! 4epq has no pacemaker in hiss
body. (CIRCLE ONE)
cer
to tify at'. f1a > the rnation of the remains and
r
direFtgep >ip sessions'have either been
removed or maybe destQy,;e ,,And:ar, p.,r�tecf;d d�Wave,harmless Pine View
Crematorium from any and:all claims OW -ds for-loss,or damages which may be made
(Maims
m.by.reas.n. f tt ate t d'y tt> cre tion<ofaaid.remains as directed, whether
or demands are br are npttWl�pJ1 =goundlesg�'fa�se-or:fraudulent.
Rt.., 28, North River, NY 12856
(WITNESS) �firf (�DAEESS)Y�
ona Warrington, Peaceful Valley Road, North Creek,
(SIGNATURE OF LATIVE OR LEGAL REP. AND ADDRESS)
Signed on this date: /D o23 - a 1
DI ,Q jTJQ_ P-AEMAINS
16
I hereby direct Pine VieW,Crdm0todum16.dIspos f theCcrerhated remains as follows:
Mail to
Other arrangements-please specify: ketb n.j tv Funeral Director
If pulverization of cremated.Te, xx
.,mgjp,A is,requ#%e_
aTIONS
'0C-,d- ME 6 REW
1 The crematorium will be open for cremations 'days a week 7:00 A.M. -3:30 P.M. Monday-
Friday. No Holida�y§.9�.§�L!gogy,4,,;@r(qpge'me.0 . be c 4D _We for Saturday. Prearrangements
by telephone for acceptance of remains is ne ssary.*
2. Pine View Crematorium i,s,l�jed on
._#19,g rQ f ftPine View Cemetery, Quaker Road,
Town of Queensbury.
3. An authorization for cremation properly signeqby the nearest next of kin or other authorized
person stating that,thel;dA,h;ave-.thetpQ.wer,,,an -authority;to arrange for the cremation of the
remains and to direct the disposition of thecri , ated remains, that any personal possessions
have either been rem-gy#04 WM bgg#W W WIN,
J9 protect, defend and save
harmless Pine View Crem�t§ 6M,,,,A -all�Cla,rn
_ny as and demands for loss or damages
Y"
which may be made againat,,them by,re I c
,,on. or connected with the cremation of said
remains and/or di§pOgqa rA iraclod,xhether such claims or demands are
or are not wholly groundlesi,jalse or fr udule t. This authorization in addition to a regular
burial permit must accompany the remains.
4. All remains must be encased in a casket,or-s—L
� . I -1.1table alternate container. Caskets and
containers must be of combustible material. No Styrofoam or plastic containers will be
accepted.
5. The question reIa4yej,9caTA pc pac6mj pst,be:answered on the authorization to
cremate form before the remains will be cc' ted.'
6. Unless other arrangqme,qt _th
q rp,made' ated remains will be mailed via Registered
U.S. Mail.within Lt-
ema0d (Y-1 ri6r4lho,me,handling,the serv
ice. There will
A-
be a$20.00;cha o V.
46,1-1
Cremation,Administration!Cd'$t6N1nd-RecordIng"F e:,,,Adult-$225.00 Children (age 13 months to
12 years) $115.00-Infanti,(stillb6im"to lZ"months) 75.,00
Additional$50.00 charge.fofZ,@,Mjlj004. 00- 3R.Q0., M. Monday through Friday.
Cremations done on Saturdays will,be charged additional$60.00.