Snody, Kenneth rT-o q+N of QUEEVBURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Directory
Name Case # 2t3�
Date of Cremation -
Time Cremation Started
Time Cremation Completed �-
Type of Container OAI-xd Voo+4c-.�-J
Remarks :
DISPOSITION OF CREMATED REMAINS
htreoti duect Cler?la(OriLri?) to dispose of the cremated remains as follows
P:l;�ij to
`Jtht?( dl(anC)t✓'mentS-I��IE)c3SN Speiaty
c,lvei zanon c:f cren?ated remains is requested, check here
POLICIES, RULES AND REGULATIONS
ThN cren? Co, unr II IDe open
i�i`'�' for cremations 5 days a week 7 00 A.M 3:30 P
N,_, f-lulici�ys or Sundays, arrangements c Y an be made for Saturday. Prearrangements
;4, telepirove fc,r rcceptance of remains is necessary M Monday-
_'_ne �icvv C, n?atonunr is located on the grounds of the Pine View Cemetery,
wvn or C�ueer?s , r) »
t uetery, Quaker Road,
`
anon r i cremation properly signed by the nearest next of kin or oth
rrsc n staur g , at then do have the power and authority to arrange for the cremation
i'rr?air?s and to er authorized
c:uect the disposiiron of the cremated remains, that an of the
I a',ie eithta been removed or May be destroyed and agree to protect, defend an
hain?iess Pu e V,e,,N Crematorium fbon? any and all claims and demands fersonal possessions
1'hich may bra Made against then? by reason of or connected with the crematrond save
rerr?`� ris �=�nd iur disposition of said ten?gins as directed, whether such claimsloss or damages
sr art' fro- whop t of said
✓ c roundless, false or fraudulent. This authorization in addiion to a reguaarare,
anal hermit n ust accon?Pany the remains.
-I -ail remains must be encased in a casket or suitable alternate.("Cef r?er ;. must be of combustible matenal. No Styrofoam o� coasainer. Caskets and
accei_tea
plastic containers will be
he q.,asrion c relative to c�1rdiac pacemakers must be answered on the authorization to
rerr?ate t��rr7i before the remains will be accepted.
Unless other arrangements are made the cremated remains will be n
U S Mail within three days of crer7�ation to the funeral home handling the s
be a ai 00
i ctn lhl- for this service wiled via Registered
9 service. There will
t;;remat;ori, Aaminis:ration Costs and Recording Fee: Adult $225.00 Children (age 13 months to
1115 00 Inf,9nts (strilborn to 12 months) $75.00
°�ddihon�;l repjaficns don .UrJ charge for cremations clone after 3:00 P.M Monday through Friday
e on Sz�turd Sys will be charged the additional $50 00.
TOWN OF QUEENSBURY
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road. Queensbury, New York '12804
Phone (5 18) Crematorium 745-4477 (if no answer)
Cemetery 745-4476
AUTHORIZATION TO CREMATE
Tile t r.iersignea requests and authorizes Pine View Crematorium, in accordance with and subject
to its Rr.iles and Regulations to cremate the remains of:
(NAME) (SEX)
(STREET) (CITY) (STATE) (ZIP CODE^
vho rhea on S 114 4 l
day of l 20 4 T
(PLACE) — 9 /"�-c. �/� � �'n�ir✓��/�/1�P� (/�fc,�•
(ADDR SS)
Narne and address of nearest living relative or name of person authorizing cremation:
Relationship to deceased
",,Q-rne of Funeral
IMPORTANT
I represent that to the best or rTy knowledge, the deceased has r has no p cemaker in his or her
body (CIRCLE ONE)
I certify chat 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 cremation of said remains as directed, whether
such claIMS or demands are or are not wholly groundless, false or fraudulent.
(�N S) (ADD SS)
X-7
,SIGNATURE OF RELATIVE OR LEGAL REP AND ADDRESS)
Signed tin tills dale. 3 4