Bearor, Gerald TOWN OF Q UEENS B UR Y
Pine View Cemetery nmi Creiunfnriuru
21 Qunker Ronn'. Queenshtrry, NY. 72804.5902
(518) 745.4476 (518) 745.4477
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Funeral Director: 4S61"
Name of Deceased: ve(4l� 3QA-tor'
Case Number:
Date of Cremation: °I/W /UI
Retort: t
Time Cremation Started:
Time Cremation Completed:
Type of Container: � 04f d
Remarks:
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r r of '\' ni ;trnl Benuty . a G o n I PInie to Lice
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:
GERALD BEAROR MALE
(Name) (Sex)
679 GOODMAN RD. , FORT ANN , NEW YORK 12827
(fit) (City) (fie) (Zip Code)
who died on 16TH d yof SEPT . 20 05
atGLENS FALLS HOSPITAL , 100 PARK ST. , GLENS FALLS , NY. 12801
(Ph") (Address)
Name and address of nearest living relative or name of person authoring cremation:
ANNE BEAROR , SAME AS ABOVE
(Name) (Address)
Relationship to the deceased W I F E
NameofFuneralHome MASON FUNERAL HOME , FORT ANN , NY. 12827
IMPORTANT: ��
I represent that to the best of my MwAedge,the deceased(has)orb no))pacemaker,defbri�tor or any other battery operated
device in his or her body. (Circle One) 49
I certify tfat 1 have fur power and authorization to anange for the cremation of the remains and to direct the disposition of the
crenated 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 al claims and demands for loss or damages which maybe made against them
by reason of or connected with the cremation of said remains as directed,whether such clairrrs or demands are or are not whory
grotrrdless,false or fraudulent.
P. O . Box 277, FORT ANN , NY. 12827
(Witness) (Address)
�� , SAME AS ABOVE
(Signature and Address of Relative or Legal Representative)
Signed on this date: SEPT . 16 , 2 0 0 5
Disposition of Cremated Remains
I hereby direct Pine View Oem corium to dispose of the cremated remains as follows:
Mar to
Other arrangemerns-Please specify:
if pubMUation of cremated remains is requested,check here X .
Revision:July 7,2004
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Policies, Rules and Regulations
1. Pine View Crematorium is bcilted on the grounds of pine View Cemetery.The
crematorium operates Monday through Fnday from 7:00am to 3:30pm. Prior telephone
arrangements for the acceptance of remains are necessary-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 ren>ain%that any personal
have either been removed or may be destroyed and agree to protect,defend and save
harmless Pine View Cemetery and Crematorirxn from any and claims of and nect�nds
for loss of damages which may be made against them by
the cremation of said remains and/or disposition of said rw&Efwm as d-rec ted,whether
such claims are, or are not wholly groundless,false or fraudulent.This authonzatwn in
addition to a regular burial permit must accompany the remains.
3. All remains must be in a casket or sable alternate cow-Caskets and
must be of a combustible material. No styrofoam or plastic corrtarners will beamWed.
4. Cardiac pacemakers,defitxiilators or other battery operated devices must be removed
before any remains will be accepted.
5. Cremations will be completed within three woftV days(72 hous)of receipt of the
Burial Transmit Permit and Authorization to Cremate Form.The cremated remains will
be mailed via Reed 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
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