Martin, Irene Ilk
L "TL N OF O UEEN5B UT rY
PINE VIEW CEMETERIY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
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Policies, Rules and Regulations
1. Pine View Crematomim is located on the grounds of Pine View Cemetery.The
crematorium operates Monday through Friday from 7:OOarn to 3:30pm. Prior telephone
arrangements for the acceptance of remains are rNKMssaffy.Prearrangements are
necessary for Saturday cremations.
2. A `Authorization for Cremation'signed by the nearest next of kin is necessary stating
that they do have the power and authority to arrange for the cremation of the remains
and to direct the disposition of the cremated r+ernain%that any personal possessions
have either been removed or may be destroyed and agree to protect,defend and save
harmless pine View Cemetery and Crematorium from any and all claims and demands
for loss of damages which may be made against them by reason of or connected with
the cremation of said remains and/or disposition of said reniakw as directed,whether
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 suable akerriat+e eordakler.Caskets and eontai*xs
must be of a combustible material. No styrofioam or plastic containers Willi be accepted.
4. Cardiac pacemakers,defibrilators or other battery operated devices must be removed
before any remains will be accepted.
5. Cremations will be completed within three working days(72 hors)of receipt of the
Burial Transmit Permit and Authorization to Cremate Form.The cremated remains will
be mailed via RegWered U. S. Mad within three days of cremation to the funeral home
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
`t
Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: 518-745-4476, Crematorium: 518-745-4477
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.
IRENE E . MARTIN FEMALE
(Name) (Sex)
608 COUNTY RTE . 12 , WHiTEHALL , NY 1 887
(Street) (City) (State) (Zip Code)
who died on 30T1-6yof JANUARY 20 05
at GLENS FALLS HOSPITAL , 100 PARK ST . , GLENS FALLS , NY. 12801
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremation:
FRED H . MARTIN , SR . , SAME AS ABOVE
(Name) (Address)
Relationship to the deceased HUSBAND
Name of Funeral Home MASON FUNERAL HOME , FORT ANN , NY.
IMPORTANT:
I represent that to the best of my InMedge,the deceased(has) has no) aker,defibdIator or any other battery operated
device in his or her body. (Circle One)
I candy that I have U power and authorization to arrange for the cremation of the remains and to direct the disposition of the
cremated remains,#0 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 ail dairrts and demands for bss or damages which may be made apa*rst 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.
BOX 277 , FORT ANN , NY. 12827
(Witness) (Address)
x ,`7JU-A A" -97"' �141, SAME AS ABOVE
(Signature and Address of Relative or Legal Representative)
Signed on this date: .J A N . 31 , 2005
Disposition of Cremated Remains
hereby direct Pine View Caerrratoriuo to dispose of the crernataed mmains as follow
Mail to
Other arrangements-Please specify:
if puMuvation of cremated remains is requested,check here
Revision:July 7,2004