Loading...
Latrell, Mary TORN OF" QUEEVBUP.,y PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director ��Y ��n L3��U S Namel'� Pr�Ll ' L Case# 3 Date Of Cremation &--2 j - -220 -5 Time Cremation Started Q g Time Cremation Completed Type of Container bYV— 1�@ C,, AA A 14 1 5 LAI Remarks 1 1 �1�(,c&C>�CJ �l C4A4; �% �� �77�''�1 /�) G �/ �C/ I f �,C� `I�^1 l �t 0 b C) ILI to fly TOWN OF QUEENSBURY PINE VIEW CEMETERY CREMATORIUM Quaker Road, Queensbury, New York 12804 Phone(518)Crematorium 745-4477(if no answer) Cemetery 74544.76 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: Mary Latrell Female (NAME) t ► (SEX) 1 Myrtle Ave. Cambridge, NY 12816 (STREET) (CITY) (STATE) (ZIP CODE) 18th January 03 who died on day of 20 McClellan Health Systems Skilled Nursing Home Cambridge,NY at (PLACE) (ADDRESS) Name and address of nearest living relative or name of person authorizing cremation: Lois Feenan 326 Elm Street Bennington, VT 05201 Daughter Relationship to deceased Name of Funeral Home Flynn Bros. , Inc. - Greenwich, NY IMPORTANT I represent that to the best of my knowledge, the deceased has dE&ino acemaker in his or her body. (CIRCLE ONE) 1 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 ematorium from any and all claims and demands for loss or damages which may be made 'against them by ason of or connected with the cremation of said remains as directed,whether claims or ma% wholly groundless,false or fraudulent. 80 Main Street Greenwich, NY 12834 SS) (ADDRESS) 326 Elm Street Bennington, VT 05201 (SIGNATURE OF RELATIVE OR LEGAL REP.AND ADDRESS) Jan. 19, 2003 Signed on this date: r DISPOSITION OF CREMATED REMAINS I hereby direct Pine View Crematorium to dispose of the cremated remains as follows: Mail to Other arrangements - please specify: will Pick up If pulverization of cremate remains is requested, check here x 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 ma e for remains to necessarye*arrangements by telephone fcr acceptance 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 l within be mailed funeralRhometered handling.thelservice. three Theredays willobecremation th to the $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.