Burnham, James Mw� t j wit`
i
TO�4N OF QUEEN,
PINE VIEW CEMETER'� AND CREMATORIUM v
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745.4477
Funeral Director d Antj,- 11A
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Policies, Rules and Regulations
1. Pine View Crematorium is located on the groLAnds of Pine View CernaterX.The
crematorium operates Monday through Friday from 7:00aun to 3:3 i Prior t snt
arrangements for the acceptance of remains are necessary. Pr ,
necessary for Saturday cremations.
2. A "Authorization for Cremation"signed by the nearest next of kin is neoessery
that they do have the power and authority to arrange for the crematkM of the train
and to direct the disposition of the crermted remains, that any persoW p "tom:,
have either been removed or may be diestroyed and agree to protect,defend and save
harmless Pine View Cemetery and Crematorium from any and all claims e"Bern
for loss of damages which may be made against them by reason of or conrtected with
the cremation of said retrains and/or disposition of said remains as dire&Ads whqkW;
such claims are,or are not wholly groundless,false or fraudulent. This authorization in
addition to a regular burial permit must accompany the remains.
3. All remains must be in a casket or suitable alternate container. Caskets and�l -
must be of a combustible material. No styrofoam or plastic containers will be accepted.
of q,lvrKa!Oej�
4. Cardiac pacemakers, defibrillators or other battery operated devices must be
before any remains will be accepted.
5. Cremations will be completed within three working days (72 hours) of receipt of the,-,
Burial Transmit Permit and Authorization to Cremate Form.The cremated remains'WIY'' '�
be mailed via Registered U_ S. Mail within three days of cremation to the funeral hom9,,,, .,
handling the service unless other arrangements are made. There will be a $25.00 charge.
for this service.
6. Cremation, Administration Costs and Recording Fees:
Adult $300.00
Children (age 13 months to 12 years) $150.00
Infants (stillborn to 12 months) $100.00
Overtime Cremations (Weekdays) $400.00
Saturday Cremations $400.00
Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road, Queensbury, New York, 12804
Cemetery Office: 518-745-4476, Crematorium: 518-745 -4477
el!; Authorization to Cremate
TAe YAOMs rtwthoftzes Pine View Crematorium,in accordance with and subject to its Rules and Regulations to
t7NIN1e the
(Sex)
(City) (State)' (Zip Code)
day of A 20 0
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RQ:d�a n9
at �i .3' 9 54 u`� 14e T AL - C-1 L-6 A-'S jf:::�(--A L L 5 A /
` VIY, (Address) -
Neme and address of nearest living relative or name of person authorizing cremation:
5 Arhn la S AR
(Address)
RNetionattip to the deceased
Name 404erai Home ry G O e._/ L L_0 /1/ 7W A141-C_
IMPORTANT:
I P11pre9efg"[to the best of my knowledge,the deceased(has)or(has no)pacemaker,defibrillator or any other battery operated
device in his or her body. (Circle One)
CW*that I have full power and authorization to arrange for the cremation of the remains and to direct the disposition of the
or+e railed 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 feason of or connected with the cremation of said remains as directed,whether such claims or demands are or are not wholly
72,e
�f�ral"
len
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(w't ness (Address)
2 9-
(Signature and Address of Relative or Legal Representative)
Signed on this date: J(
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows.-
Mail to
Other arrangements-Please specify ZZ,1/ C T-/If pulverization of cremated remains is requested,cneck here_
Revision:July 7,2004