D'Ahilio, Elizabeth o rwN OF OUEEN,5BUTrY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745.4477
Funeral Director Uj ; �cox
I—
eTe • i Cased
'a : e Or' Cremation ( L
- -•e Cremation Started
. . ' e Cremation Completed
' . ,e of Container Clu}� C sl/t - T FF
.-ar s
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• , I
DISPOSITION OF CREMATED REMAINS
b direct Pine View Crematorium to dispose of
I here y
remains as follows-
mail to ------ ----
Ot er arrangements - please specify: uested, check Here__
If pulverization of cremate remains is req
POLICIES, RULES AND REGULATIONS
will be open for cremations 5 days a wee}' 7 . 00
1 ' T crematorium Monda Friday. No 11olidays or Oundays'
A.M. - 3.•,30 P.M. Y" Pre-arrangements by
ry.
arrangements can be made for Saturday. *
telephone for acceptance of: remains is necessa
" rounds of the Pille
wine View .Crematorium is located on the g
View Cemetery, Quaker Road, Town of Queensbury.
roperly signed by the dearest
3' An authoro Z ther authorized perion for cremation son stating that they do have
next of kin to arrange for the cremation of tile-
the power and authority
remains and to direct i:he i have tei other f been removeddor e,«aynbe
that any personal possessions
destroyed and agree to protect, defend and save harmless Pine View
Crematorium from any and all claims and reasondemands
or c �s�` t�
damages which may be made against them by
said
with the cremation of hether such claims/oor demands disposition
or are
remains as directed,
not wholly groundless, false ° naccompanyatheoremains11 �11
addition to a regular burial permit must
e alternate
4. All remains must be encased in a casket orbeulofblcombustible
container. Caskets and conta
material._- No Styrofoam or pla stic containers will be accepted.
5, The question relative to cardiac pacemakers must be answered
on form before t}►e remains will. be
n the authorization to 'crei
accepted.
k 6. Unless other arrangements are made the cremated remains will
be mailed via Regiftered U.S. Mail withi
threreee dayswil of cremation
to the funeral home handling the service
charge for this service.
-00
Cremation, Administration Costs and Recording$1 00 Fe : Adult
0
Infants (st011borii
Children (.age 13 months to 12 years)
to 12 months) $100.00
* Additional $100.00 charge for cremat orisne
on one ofter Saturdays
*will' •be
Monday through Friday. Cremations do
additional $100.00 Any remains received after 3. 30
the additi
. charged will be charged an additional $100.00 .
p,M. Mon-Fri or Saturday
. • 33.
TOWN OF QUEENSBURY
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road, Queensbury, New York 12004
Phone(518)Crematorium 745-4477(if no answer)
Cemetery 745A4.76
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.
(NAME) (S )
R nIS AIA, Zai'
(STREET) (CITY) (STATE) (ZIP CODE)
who died onf day of 20 A`t.►
(PLACE) (ADDRESS) dA u l
Name and address of nearest living relative or name of person authorizing cremation:
Relationship to deceased
Name of Funeral Home ,14/4
IMPORTANT
1 represent that to the best of my knowledge,the deceased has or aTaker in his or tier
body.•(CIRCLE ONE)
I certify that 1 have the full power and authorization to arrange for the cremation 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 harmlM Pine View
Crematorium from any and aN claims and demands for loss or damages whIcTnmy be made
agalnst 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.
TNES (ADDRESS)
�i
(SIGNATURE OF RE TIVE OR LEGAL REP.AND ADDRESS)
Signed on this date: �(