Osborne, Maureen TOWN OF Q UEENS B UR Y
Pine View Centetery nnrl Cremn tort ItM
21 Qunker Road, Queenshury, NY. 12804.5902
(518) 745.4476 (518) 745.4477
htrp//w%v\v queensbury net
Funeral Director: G
Name of Deceased: ,AA IN
Case Number:
Date of Cremation:
Retort: fi)
Time Cremation Started:
Time Cremation Completed: `3 G I�'ti1
Type of Container: � � 1�� dIZ�� /4
Remarks:
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Ho it nj NntulnI Beauty ... A Cnnit P I n c e I Live "
DISPOSITION OF CREMATED REMAINS
I hereby direct Pine View Crematorium to dispose of the cremated
remains as follows:
Mail to
Other arrangements - please specify:
If pulverization of cremate remains is requested, check here
POLICIES, RULES AND REGULATIONS
1. The crematorium will be open for cremations 5 days a week 7:00
A.M. - 3:30 P.M. Monday-Friday. No Holidays or Sundays,
arrangements can be made for Saturday. Pre-arrangements by
telephone for acceptance of remains is necessary.*
2. Pine View .Crematorium is located on the grounds of the Pine
View Cemetery, Quaker Road, Town of Queensbury.
3. An authorization for cremation properly signed by the nearest
next of kin or other authorized person 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 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 of
damages which may be made against them by reason of or connected
with the cremation of said remains and/or disposition of said
remains as directed, whether such claims or demands are, or are
not wholly groundless, false or fraudulent. This authorization in
addition to a regular burial permit must accompany the remains.
4. All remains must be encased in a casket or suitable alternate
container. Caskets and containers must be of combustible
material. No Styrofoam or plastic containers will be accepted.
5. diac pacemakers
ust
The authorizationion tive to'cremate form before the m i answered
rema ns w ll
on the be
o
accepted.
6. Unless other arrangements are made the cremated remains will
be mailed Registered U.Sl within
three
Theredays
willo cr
via emation
to the a$ 5.00
charge for this service.
Cdrnn• Administration costs
and Recording
Fe t
0-00
Children (age3 months to12years) $150 Infants (stillborn
to 12 months) $100.00
* Additional $100.00 charge for cremations done after 3:00 P.M.
Monday through Friday. Cremations done on Saturdays will be
charged the additional $100.00 Any remains received after 3:30
P.M. Mon-Fri or Saturday will be charged an additional $100.00.
TOWN OF QUEENSBURY
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone(518)Crematorium 745-4477(if no answer)
Cemetery 745-44,76
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:
,�ALAREEN �hu\�E. C 156�RNE, �i;.MRIF •
(NAME) i , (SEX)
O
(STREET) (CITY) (STATE) (ZIP CODE)
who died on 31 day of Im k\ 200,
atQ.,�'tAFFoLF-- PARrL 0-tP- ,-- PR-F, I.Fr� Mss3cAelA�7�,oRk 14'Ta
(PLACE) (ADDRESS)
Name and address of nearest Irving relative or name of person authorizing cremation:
�- Cam. L, c4,GHu0�o .. ► OC �2oAfl, (�i �a Nss�uRv. � c� aRlz 1-1?0'�
Relationship to deceased —'c1;pAu&kxm2
Name of Funeral Home
IMPORTANT
I represent that to the best of my knowledge,the deceased bas r has no acemaker in his or her
body. (CIRCLE ONE)
I certify that 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
. ;matorium from any and all claims and demands for loss or damages which may be made
°against them W9ason of or connected with the cremation of said remains as directed,whether
s emands are or are not wholly groundless,false or fraudulent.
(1MTNESS) (ADDRESS)
t a.s�
NATUR F RE TIVE OR LEGAL REP.AND ADDRESS)
Signed on this date: ��