Bateman, Albert rrnWN OF QUEEM5B U.OKY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, 'NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director /9, rx 'dLI
Name �,�„b�� , g 7,�i✓I,c��l Case # p� O
Date of Cremation
Time Cremation Started 4�1s �`J /vA
Time Cremation Completed ,
Type of Container �/9/?Q,�o�}��
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TOWN OF QUEENSBURY
PINE VIEW CEMETERY
a
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 745-4477 or 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 remaina• of:
Albert C. Bateman Male
(Name) (Se)()
PO Box 23, Gansevoort, New York 11831
(Street ) (City) (State) ( Zip Code )
who died on the 16th d a y of January 2002
at The Glens Falls Hospital, Glens Falls, New York 12801
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation :
Mrs. Vina Tennison
(Name) (Address)
Relationship to the deceasedDaughter
Name of Funeral Home Alexander Funeral Home, Inc.
IMPORTANT:
I represent that to the best of ray knowledge, the deceased XXiQOMk
has no pacemaker in his 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 then by
reason of or connected with the cremation of said remains as
dir--#ct�d, whether such claims or demands are or are not wholly
g- o dless, false or fraudulent .
��Z---- - John S. Alexander, 3809 Main St. , Warrensburg, NY 12885
(Witness) (Address)
PO Box 23, Gansevoort, NY 12831
(Signature of Relative or Legal Rep. and Address)
Signed on this date ; April 20, 1996
DISPOSITION OF CREMATED REMAINS
I hereby direct Pine View Crematorium to dispose of the crematec
remains as follows :
Mail to
Other arrangements - please specify ; rt7 13
If pulverization of cremate remains is requested, check here �[
POLICIES, RULES AND REGULATIONS
1 . The crematorium will be open for cremations S days a weep
7 :00 A. M. — 3:30 P. M. Monday—Friday. No Holidays or Sundays ,
arrangements can be made for Saturday. Prearrangements cy
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 connectec
with the cremation of said remains and/or disposition of sa : c
remains as directed, whether such claims or demands are, or are
not wholly groundless, false or fraudulent . This authorizat . o-
in addition to a regular burial permit remains. r must accompany te
4. All remains must be encased in a casket or suitable alternate
container. Caskets and containers must be of combust : c '
material . No styrafoam or plastic containers will be accepted. e
S. The question relative to cardiac pacemakers must be answerec
on the authorization to cremate form before the remains Wlll ^e
accepted. _
6. Unless other arrangements are made the cremated remains
be mailed via Registered U. S. Mail within three days of cremat . —
to the funeral home handling the service. There will be a s2o. o'�
charge for this service.
Cremation, (Administration Costs and Recording Fee : ;:
Adult s ! ,5. ;
Children age 13 months to 12 years ) $ 100. 00 Infants ( s175. o
to 12 months ) $60. 00