McCabe, Henry l D Y Y N OF QUEEMs5BURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY. NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name Case # Q<� �f
Date of Cremation
Time Cremation Started 1 JI.-M/Ny
Time Cremation Completed 1 3a 6m.
Type of Container e r41?17&4/,f2 3 JJ.If
Remarks :
37/13/2002 11:41 215-986.-0567 UNIS'YS E-BUSINESS PAGE 01/02
07/12/2002 18:'?5 518-584-0147 I1. J. BUPKE & 5" PACE 02
TOWN OF QUEENSBURY
FINE VIEW CEMErERY
CREMATORIUM
Quaker Rosd,Qupnebury,New York 12804
Phono(616)Crematorilrm 745.4477(if no answer)
Cemetery T454476
AUTHORIZATION TO CREMATE
The Wined mque3ft W&AhWhO Rine Yiew CrematOdUrA'In accordaro wAh and subject
to b Rules and Regulations W cremate the ream of:
HENRY mcCADU MALE
4 ;FOWLER. LANE, GAN5 1TORTr NY 12831
( (cny) (Si TA (ziP CODE)
wIw died m 12TK der ot• J UL Y • 20 0 2
SARAT GA A SARATOGA 5 RINGS NY
(PLACE) (ADDRESS)
Now gmd address of+nearest wing relative or nam of paten►as n9 crew uWw
• S AN CAGE A ST2E HI�L,L PA •
Remoonv*bo deotasWd DAUGHTER
,eofruww Homc WILLIAM J. BURKE & SONS
WORrAKr ker in his or her
t reprowd th4tt to the beat of my la>Qw Q, •deoeasod has
body. (CIRCLE ONE)
I MOP that I have the NQ power and authoriaatdon to affW, for the crerr+�rdon s have either been
tp dreg the dlsposWon of the Clued terralins,OW enY•Perrionat vaeaeas
or mad be destroj►ed,and to p defend aril$0"JWTntess Pine Ytew
from�y and a n dal m and demands for Im or d�mages.which maybe made
ag&st 0cm by reason of or connected with tt►e s s ut s�i�1s
demands or are no(whody orth Broadway
Saratoga gy�rtn�s,Now York 12llQ6•
lop oWFWJ
(VO
{ADD )
2LC
CAR L REP.AND ADOR )
o
Sighed on#6.dates
07/13/2002 11:44 215-986-0567 UNISYS E-BUSINESS PAGE 01/01
urrlc<<nnt tts:35 518-584-0147 WM. J. BURKE & SONS PAGE 02
TOWN OF OuE'SKSBURY
PINE VIEW CEMVERY
CREMATORIUM
Quaiarr Road,'Quw,,sbury,Now York 12604
Phone(618)Cremado Wm 740-4477('d no enwer)
Cemretory 7e
AUTHOR17.AT1ON TO CREMATE
The undeleigned r s erxf AtIkfia e5 Pima View Crematorium in accordance with and subject
to its Rules end Regukikm to oremats the remains at:
HENRY MC'CABE MALE
r 4 )YOWLER:LANE. GANS9V00RT,• NY 12831
(STA (ZIP com
12TR JE5i�fS#tUt��ULY 2b 0'2
' wig died� �TIT'���r..�r.
ad ARAT G ', 8 lip—
Phone i NGS NY
( Quakesbury,Ptew 1°ciric 12804
(516)Ccernatodum 745-4477(if no en",er)
Name wW ad*wn of now.a t liviig relative a 4 i 7 moo"o'emaom
STJS.9.N UCASS, LAFAXam}>pi}'x u - �rx�7lsn r•o :t�1�E
The.uqd@ sd;re mats at Pine View Crernatoriu n,in acmdance•w6 and subject
ES�sVRY •McCABk. �s�•
x x
ANT''
1 trapreeent ti�at b the bent of my knpwtedpo.the.deceased at l d Oerrwker In his or her
body. (CIRCLE 0N1-)
t' tl�'1 12 eS.-fif��e+,�efifft�l� u Y
' feb d'med the dispoelHonof the oterrisbd rwrr�trs,�arry.per�ofrat �hanre eitrier t>Ben ,
a Pine View
ebsvn of a aer,tat8vti of 6w. �e�ne
dema�tde or tare nat t�r1101p SrhuttdIM,to a er orth Smadway ;
s G ' i*e or name of pervon a� , York 1200.
S A� L-,F,a � A, A.
G:._ �(YNW011101, t!Y1�C —^ -F r l
'' a,thia.date� - f 3-o (O
_ P .
Ka of Fwwww H9rne
body.
$LenG. ONE)
'
I #1r3i t have the fail pmwr and"ho tt stion to anrarree fir the cremation of the►remains NXI
to direct the disposition of the rretriaW remains.,that any p r*p9mmlom hm eNw been
Or'may be destroyed,and agree tQ MW$,deleud and save.harmless Pine View .
r. �*=any s hd fi'cWn and demands*arias$yr d which may be made
• DISPOSITION OF CREMATED REMAINS
I hereby direct Pine View Crematorium to dispose of the cremated
remains as follows:
Mail to
Other arrangements - please specify: [-� IGL
If pulverization of cremate remains is requested, check here
POLICIES, RULES AND REGULATIONS
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 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 of
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 $100. 00 charge for cremations done after 3:00 P.M.
Monday through Friday. Cremations done on Saturdays will be
charged the additional $100. 00 Any remains received after 3:30
P.M. Mon-Fri or Saturday will be charged an additional $100.00.