Banach, Andrew TO'wQ OF QUEEN,5BUP
_y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4-477
Funeral Director
a-7e .f) NaXIZV1 r3AA461-7L- Case;, - 1
`ate Of Cremation
--e Cremation Started
-re Cremation Completed — ( J
e of Container 1—J/-A1Z vG63 (^,wcllc'k-' 17
T-
jemarks
!
f'}ISPOSITION Or CREMATED REMAIN
l
1 erpby!irlirect. piny,view Crematoriurn to dispose of the cremated rc-;rr'rain.; as tallow;;:
ailCo � ..._......_._..... .._�.....___... ,_.._—_�.M..-.---....____._...�..•_..._...._..._._____..___..__..., ..._.._..�.....__.w_....__..,.........__......_
._
t.lrer:altiange.ments-please
i
Iflpulyeril-atiorr of cremated rrsrnains is requests d, cher,k flare....._..., ..._,
4 i
PtJf.,1C;iF�:�, }jjjl[_ES AND I'�.EC7l.II..A CIL�Id
r P.n far crerr;at;cxls 5 days weei<..OO AM 3:30 P M. Monday-
1�, 1"t"ia cremat:011Um will br. np
I:ri y.
Na Holidays or Sundays, arrangc�rrrents c,at7 tie made for Saturday, l"7re-arrangem+�nts
by telephone,for acceptance of r'ernains !s r'recrasraary "
F7ineiView Cretn��toriurn is ir�ral:ed cart tl,ci grounds of the Pinc� Vir.,w Cnrr�etcry, Quaker Road,
1"tow6 of Queensbury
n or other
orized
3 An a6thorization for crcanlati�nvprthe rxiw�lnancied k'ar.rtt?orikya#r���rrar ge for the cremation of the
person stating that they do a I that, any personal
rerna;ins acid to dirpot tivc�c�c5r}may bee+fe the
`trc,ye!rar>ti a�ma;ir�protecl. defend ands ave ssrana
havF,either been removed
hrrnless fine View C.;rematar;um frarn any and all c,lail7��. and c1c rrsands for loss or darnacges
wf,ic,fi may be rnasle against
of sraid� ernains ati dires�lcrd vvt?ether sur hectorclai slrorr dema of nds are,
I retyralrls and Icrr dispo.
or ark: not wholly groundless, false Or fraudulent. "t"his authc.7rizaiJon in addition to a regular
bcarial lsermii; roust a.ccornpai the r'r'n,ai IS
'as
and
afte
q.. All re'rnains mras[ bP ran d k I<�;a} c.rr(�r1.41QoaStyrrsfo-v tm 01 r.)!asiirc c;ontainsk stwill be
c,ont3iners rrlust be of rnm
accepted
3�. T{�c rr.JErSt:on relative tor:�rciiar; par:E�r��akerr muss be ar�aw�rec.i qn the authorization to
cremate form hefor(n the rernains vvill 1)0 ac cel)ted
G. I.Inles's other arranger�nent5 7f r•rr�r7 ati±�n to c nerai nme l
ta fr ancfling the servil be mailed via eservice.DTI arc dwlll
y t.l'7. Mail within three day.
be a $02 00 chaM6' for this service.
on Casts and I'�e(,ording i:'ee: Adult `li300 00 Children (age 13 months to
C mr�ti±��:r. Adrr?inis&atr
1', ye rs}'$1E�().O() Infants (s:;i.illk>c�rn tr} 11 nianih!) $100 00
ddii;icariai �() 00 charge fear r,.rernr.jik)r)s clans offer 100 P NA M0 relay through Friday.
C rn tioi s done on Saturdays will be cl",arg{-:cf tile addii;onRI $r�C.O(.i.
i
I
'i
i
TC�WN or 0tJ'EFNSBUPY
PINE,VIEW CEMETERY
&
m-.mATORMIA
Quaker Road, Queensbury, New York 12804
'74S4477 (if no answer)
J)Onp (5 18)
Cemotery
AUTHORIZATION I
t
'Im jr, accordance wHh and subject
The undersigned request and authWes pine vow (Dornatont
la1ior1,,3 to cA'ernale the, remains01'*
its roses and Regii
i Andrew J. Ba
(Sex)
i(NAME)
P 0 Box 343 Lake Placid, NY 12946
cor5r..)
(CITY)
day of
`who died an
................------
('DORESS)
(Pt..ACE)
f neareSt living relative or name cif Pef5On auti,iorizing creMatIOIT
Na!Tle'and address 0
Idl
Fr
ROWAMP to
NY
F-ijj)eral Home..........H R— 12946
fIi
lmff'xRTANT pacer,,ai<er in his or her
I repr6sent that 10the best Of My knovvle(.190F, the d
I
(CIRCILE ONE)
. and
certl f�y ti-Ist I have the rnation of the remains fl.111 power and authorizaiion to apange f, the cfLa
to durbit the dlSPOS-MOV) of the cremated remains. that W personal possessions have either been
removed or may be destroyed, and agree k) protect, defend and r;avp harmless, Pine View
clerAW06MI ump any and all cl@jrris and dernands for 1()SF� or-damages which may be Made
again'st.tf'iern by reason of or conneoed with the crernation of sa.i('i remains as directed, whether
such'claims or denipnds ore or are w whafly grWndless, f a15e r3r frauduient.
.....p
27 ...
(AnDRESS)
------ R=,ATNL, OR L.E.,GXi-TT.F.
2)
L-z
Fjignt d on this