Curry, Helen rr11�0�� OF QUEEX-,5BU�
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director , )!�-Xd ,9
Names (> Case #
Date of Cremation
Time Cremation Started&i� /� ►
Time Cremation Comoleted
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TOWN OF QUEENSBURY
PINE VIEW CEMETERY
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CREMATORIUM
7
Quaker Road, Queensbury, New York 12804
Phone(518) Crematorium 7454477 (if no answer)
Cemetery 7454476
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-
Mrs. -Helen T. Curry FPmaIP
(NAME) (SEX)
PO. Box 84; West Main Street, Indian Lake, New York 12842
(STREET) (CITY) 4STATE) (ZIP CODE)
who died on the 20th day of November 2001
at The Adirondack Tri-County Health Care Facility, North CrPPk, N_Y_
(PLACE) (ADDRESS)
Name and address of nearest living relative or name of person authorizing cremation:
Mr. James T. Curry - PO Box 84; Indian Lake, New York 12842
Relationship to deceased Son.
Name of Funeral Home Alexander Funeral Home, Inc.
IMPORTANT
represent that to the best of my knowledge, the deceasedimEQr has no pacemaker inher
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 personat 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
by reason of or connected with the cremation of said remains as directed, whether
such clai or demands are or are not wholly groundless, false or fraudulent.
John S. .Alexander
9 Main St. Warrensburg, New York 12885
( S) (ADDRESS)
James T. Curry, PO Box 84, Indian Lake N.Y. 12842
(SIGNATUREQF RELATIVE OR LEGAL REP. AND ADDRESS)
Signed on this date: November 21, 2001
DISPOSITION OF CREMATED REMAINS
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mail to
Other arrangements-please specify: Return to Funeral Director "1 61
If pulverization of cremated remains is requested, check here X _.__..-
POLICIES, RULES AND REGULATIONS
Y
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. Pre-arrangements-.IT
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 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,
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 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$25.00 charge for this service.
Cremation, Administration Costs and Recording Fee: Adult$300.00 Children (age 13 months to
12 years) $150.00 Infants (stillborn to 12 months)$100.00
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.