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Huenerberg, Lena ZO 4N OF QUEEVBUP,,_y PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director /P/co x Name_ C�1 A/, pr >911 Case# Date 0[ Cremation -Z 06) Time Cremation Started 9 _ ?)© ,i✓v Time Cremation Completed 1 Z Type of Container G4A-4-d TZ�00-•yZd Remarks l I�s 14 1l e� A�/o� J 1 Ll #.I I I I i I 15709/2003 : 13:37 _ 5185854475 WILCOX REGAN PAGE 01 NEW YORK STATE DEPARTMENT OF HEkLTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex :..x:.. Lena K. Huenerberg Female Date of Death Age If Veteran of U.S. Armed Forces, 6/4/2003 93 yrs. War or Dates No Place of Death Hospital, Institution or City, Town or Village Town of Putnam Street Address 5129 Bay View Way Manner of Death ff]Natural Cause []Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title MAx Cross an, M.D. Address Granville Health Center, Granville• New York a. Death Certificate Filed 4 District Number Register Number City, Town or Villa Sown of Putnam 5763 1 Date Cemetery or Crematory Burial 6/6/2003 Pine View Cremabvey Address Cremation Queensbury, NevYork Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of �]Transportation Shi meat by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Wilcox & I e an Funeral Home 01983 Address 11 Algonkin St. , Tico deroga, New York 12883 Name of Funeral Firm Making Dispositio i or to Whom Remains are Shipped. If Other than Abo e Address Permisslon is hereby granted to dispose of the human remains described Above as indicated. Date Issued Registrar af Vital Statistics I :M signature) District Number Place I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition (04 0- 3 Place ci Disposition el 1 E.M i-C)Q, j (address) I (,�cti )l2"`fi 6(�t09Hb-F) (grave number) Name of Sexton or Person in Charge of remises C9- 't•t f F— � (please print) _ Signature Title V e/;'14 to 55 10 8 -DOH 15 ( / 9) p. 1 of 2 VS 61 I ' TOWN OF QUEENSBURY PINE VIEW CEMETERY CREMATORIUM Quaker Road, Queensbury, New York 12804 Phone(518)Crematorium 745-4477(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 remains of: _Lena K. Huenerbera Femal (NAME) t t (SEX) 81 Butler Blvd. Bayville New Jersey. 08721 (STREET) (CITY) (STATE) (ZIP CODE) who died on 4 th day of June 20 0 3 1�;ew ioa Au f n a m S fQ 7�r O A) (PLACE) (ADDRE ) Name and address of nearest tnring relative or name of person authorizing cremation: Relationship to deceased Name of Funeral Home Wilcox & Regan Funeral Home IMPORTANT I represent that to the best of my knowledge,the deceased as has no pa maker in his or her body. (CIRCLE ONE) 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 them by reason of or connected with the cremationafls�fraud remains�as directed,whether such claims or demands are or are not wholly groundless, ESS) (A D ESS) d (SIG RE OF R VE R LEGAL REP.AND ADDRESS) Signed on this date: 6/9/2 0 0 1 DISPOSITION OF CREMATED REMAINS I hereby direct Pine View Crematorium to dispose of the cremated remains as follows: Mail to Other arrangements - please specify: 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.