McCalvin, Jennie /--nrTVN OF QUEEN
T 5BU-r�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director 13 041, 4czI
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`aTe )— n/jV L C,G At- Case,'-, a I
Date Uf Cremation -7 L1 _ 2 C) Cj �
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Tame Cremation Started
.. i-re Cremation Completed
T o e o I C o n t a i n e r
remarks
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TOWN Cat" OUEFW'313UP'Y
PINE V(EW CEMETERY
(,,R,P\AA'T0P--iUtA
Ouaker Road, Queensbug, New, York 12804
Phono (5,18) cret-natorlum 7454477 (i( 1-10 answer)
745-4476
AUTHORIZATON 10 CREMATE
(-,corda.,T)OP, With and subject
View in a
'lIletindersigned requests and authorizese
ills of,
and Regulations to
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FgX)
(11AME)
0,-7 -F
(CITY) CODE)
(STREET)
(Jay of ......
Who djed an
L 4
T,
ng cre%rnaflom
Name 1 Qnd address l
cA nearest INing reWhys or name (A pemon auDnk 0,
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Rda
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NO of Funeral Home 91 All- )2- Yu
ZA x /9 tA C//-
acernaker in his or her
IMPCYPTANT (nowledge, the (ieGeased t1gs
Kest 1 rieprbsent that 10the _St Of MY I
bqdy,! (CIRCLE ONE)
tion of the Fernains and
-1-Nnge for the crerna
(g3ril(y that I have the flill power and autl'Ofizaii0r' t() at e either been
of the crernatn(,l rernafris. cat any personal poSsessiOns 11av,
to dir6c.t.the disPclsifion k) protect, deferid aridharmless Pirle View
do A, and We h may be Made
re,moved of nlaY I)E, stroyp s or darr)aPs whit,
r'S a rnands for 1()9
fron) RnY arld all C"')" d dt
reason of or conneaed with the cremaon of Said rej7,j,,)jj-is as directed, wholhe
agalAst Uieni In fWse or hauduWrit.
S.vchiclj3lms or-demands are or are jmt wholly groundess, A/Y
let:
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-AAT I C P A P1 5 T1 5115 T
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Fjign nd on ijiis ........
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DISPOSITION OF CREMATED REMAIN
l erc;by;ctireet Pine View Crematorium tO ciis`�ose cif the, cremated rc-;I-rrains as follows,
t ail Co ,i ..._...[-vl,..��_�.�u2�C .f/_.��...._—__....T........�._.._..._._._.__...__..—.... �.._.._.�...�_.......�..,.�.._..a�_
i.iier• ar!ange.rnr�nts iatease spec..ifv:__.--,-._.._
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Iflp!alveri ation of c,rernated remains is regt+E�sted, checkherr�.,...!
POLICIES, RULES ANE) REGULATIONS
11 "i i!e Icrema`ot'ium;Acitl be open for crernations 5 dayS a we& 7TO A.M 3.30 P.M. Nianday-
I i=rld Y. !�v Holidays or Sundays, arrangements can be rnacie fe)r ,:aturday. Pre-arrangements
by telephone,for acceptance of re(na(ns rs r,erras.aary
2 . Pine iVieva C)rprne�tt7riurn i s ir�rated on the grc�und<s of The Pir)ca Vir.:w Cernetery, Quaker Load,
ToWO of Queensbury
Dr ther
3An a 3thorizsation for (:'enlatic>nvprtre rxrwefflanded 1atd re+-rtrtorityatc�arr�a(1ycst rirl,Xl �for the cremationhoftthe
r person stating tt-tat they do ha {
rr�rna;irts anti tta dirr.,ct they dispositior, cif the cremaemains, that. any personal possessions
havF"either been removed car n7ay be cir=�troyect ar,d agre:(e to {aroteci., defend and save
h rrnjess faints View C.,rematariun�from any and All clair�ris and demands for loss or damages
which may be made against thery� by qi ason cal or rnnner.,l:c:d wii.l7 t:trr� c l rriation of said
Irnrr7ajns and Ir,�r disl3a��rtiran of sari rernrt+ns rrs cfircr_fed, vvt�ether srrc;h claims or demands are,.
(>r ark not wholty groundless, false' Or fra(.iduleni. '("his autht.7rizatirrn in addition to a regular
br�ri�al permif: must accompany the rc maim;
q All rt rnains m+art lae encased in a casket car suitable alternrai.e cnr+.i:airter. Caskets and
contaiir!ers rrjusi I)e of can _)usi.itflc ntatci'ial IJo 5tyresfo�am ,r piasiir,.; containers will be
lrac.cepled
�. Tlat'r(.,it stion relative tr.� c:ardiac pacemakers must be answemd on the authorization to
crernate form befOIT' the rernains will 1)0 accepted.
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G.I I.lr�fess r.,i:iusr arrange+'r(E~nts rare made iiir: c•rerrr�,tr�ri renr�:�in� vdi4! bt mailed vier f�eyistered
yto the funera(
t.l:`:7. [ulail within tilree days of crenlatkxl 'tcamts ttranciling the service. There will
be a $25.00 charge far this service..
m��tit:>�t. Adrninistrati(an C;osfs and ({(;t,ording Fee: Adult `G;300.0(l C;laiidren (age 13 months to
1'`. ye-irs)j$1 50 00 lnfants (r:,lillborn io Q manlhr $100 Of)
dditicsria! 5() Op charge for (-retnaik�ns cirx(o rafter TOO P inn Mo I,I( ly tEtrotagh Friday,
C lerrnatiok done („)n Saturdays will he c;irargr:;d the <addiiionRf T,50 00.
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