Owens, Beatrice LO Y VN OF QUEEM Iky
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, ti'EW YORK 12804
(518) 745-4476 (519) 745-4477
Funeral Director hz.Ex nE! �
Name 13�'A�R 1 C. C'1 c,� /�!S Case tt /Z
Date of Cremation` I
r
Time Cremation Started rm
Time Cremation Completed 16 '6:2 / MC
Type of Container ad lYI»99D .11q ],
Remarks : ��, , �
TO RUR
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C MATORIUM,
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Qker Roae dry,New York 12804
Q1I '' G fi �ffino answer)
C1te1r�y as=4a76
AUTHO A 0N'TO CREMATE
to its Rules and R �u
The undersigned ragya�1 �tf.�oriz;; � i��►,,Crematorium, in accordance with and subject
l,,a•.ations re at a aihs'of
.._ ... ..., ......._.,.. ,.e . +r4rWJe>x�is,Aw.d .ls.c4.,.. .., Y''• '
Beatrice A. Ownes le
(NAME) (SEX)
520 State Rt. 28N, North Creek, NY .12853
(STREET) CIT1n= ., r (S•TATE) (ZIP CODE)
who died on- 222,nd . r : . ��y f :,:x�: '`Novx:, 20 01
. .. ZJ�+j�iliT,i'i?!'!•'�'.IflH�;;�:.[l i� t:..R,.::i:
,at : Her- Horpe br,4$
(PLACE) ',;(ADDRES,$Y':
Name and address of nearestrliving:relatiudImname,of:person authorizing cremation:
Herself•-Prereecn �:
i,7an.y.�.y�{"wJA= J'g -
,: .,, .. ,.':y•„ iad( '., .�i±N+a�ra.S�' ¢�Y t�.;.t�w:,t•i 2ili•i,
Relationship.to.decease 7 .
Name of Funeral Home Alexander FH, c. , North River, NY
,c�'s,';�+,
f ......,. :'.'. t,?�'F.iKMA,{ 71'i.°f, :44i{• A'fdrl.
IMPORTANT
I represent'that,toJhe,p, tyo no pacemaker in his or her
body. (CIRCLE ONE)
1-cpr4l' ja .�;.ha n s ^tl�e mation ofthe remains and
to direr the, lwagii, :passions have either been
removed or may.ba'des y J, afire s ect;d c1}Sa4,4,armless Pine View
,. ,.:.
Crematorium from an an a $c 4.6 and.: man s foraoss or damages which ma be made
against by':rea onpf'. ` Gt�d;vjth; �cre �tiontipf;sald'cemains as directed, whether
s c aim or demands are or are npl<�1+�f��lly,grpnd)$ssfajseor.fraudulent.
�• ;. 1arensbur NY
(WITNESS)
Same as above
(SIGNATURE OF RELATIVE OR LEGAL REP.AND ADDRESS)
Signed on this date: /J — 22 — of
Dl$i?,Q I71OM TEp.REMAINS
• .: . fiT.y.',1 4�`�I t �'dj Fn{1=n Y i�5•..i..
I hereby direct Pine View�.Cretn0totiumito`dspos f the"cremated remains as follows:
Mail to
Other arrangements-please specify:
If pulverization of cremated.remains is [egt{g dad, ,heGk,here,
'R.00CI,ES;R l[E3"A ID`RI1!dUI.ATI0NS
1. The crematorium will be open for cremations#days a week 7:00 A.M. -3:30 P.M. Monday-
Friday. No Holidays"or..Sugdays,arrangeme .cp.bg,made for Saturday. Prearrangements
by telephone for acceptance of remains,is neossary.*
2. Pine View Crematorium is:lopated on%§.grp40.gAgf,the.Pine View Cemetery, Quaker Road,
Town of Queensbury. _rr.
3. An authorization for cremation properly signed,by the nearest next of kin or other authorized
person stating that the)Fda.haveshe:poWer,and,authorilysto arrange for the cremation of the
remains and to direct the disposition of:the crenated remains, that any personal possessions{
have either been remaVe0,,0_&�.My, be•, gy awe t9 proteet, defend and save
harmless Pine View Crematorium from; n a :all'claimsand demands for loss or damages--..which may be made against them by rep,son,. or,connected with the cremation of said
remains and/or dis i' sald re direoted..whether such claims or demands are,
p>�stIQRRf:
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 rpust•be answered on the authorization to
cremate form before the remains will be accepted.
6. Unless other arrangementsyar .madwthe,t, ated'remains will be mailed via Registered
U.S. Mail within threeydayrematfot' to'th nerahhome`handling the service. There will
be a$20.00'charge
e fonthis
Cremation, Administration'Costsand'.Recording"Foe: Adult$225.00 Children (age 13 months to
12 years) $115.00� Infants,(stillt oMn to 12'months)`$7&00 .r.,
Additional$50.00 charge fpr,.. @mations,dpoe_ flr :QQ.RM.Nonday through Friday.
Cremations done on Saturdays will be charged thh additional$50.00.