Hinds, Charles a
s TOWN OF QUEENSBURY
/ Pine Vieth Cemetery and Crentn tort unt
21 Qunker Rond, Queenshttry, NY. 72804.5902
(518) 745.4476 (518) 745.4477
http ttw\vNv queensbury net
Funeral Director:
Name of Deceased: Ci u A\Z, L (,J �
Case Number:
Date of Cremation: Q
Retort: ("' 0, . )-C-c)\2 (J
Time Cremation Started: 1 LI h
Time Cremation Completed:
Type of Container: �l� 12 , (,raa� `
Remarks:
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PINE VIEW CEMETERY
TOWN OF QUEENSBUr�y
PhOne(5,18) Crematorium 74�4477 (if no answer)
AUTI-JORIZATIC)14 To CREMATE
The undersigned requests and aUthorizes Pille View Crernatoriurn, in accordancewith A subject
to its Rules and Regulation$ to cremate the remains o'f:
CHARLES If. HINDS
89 Greenwood St.-, Lake Placid, NY 12946
(STATE) (ZIP CODE)
who died on 17th --dayof
CREMATORIUM
Narne and address Of nearest living relative or name of person atithorizing cremation:
Cindy Hinds Horrocks Cobble Hill Rd. , Lake Placid
Relationship to deceased
Name .. Funeral nw'
Lake Placid, NY 12946
IMPORTANT
represent that to-Adbest of my knowledge, the deceased has or as
""°/ ("/n��cunE) ��----� —
I certify that I have tM full power and authorlzation to arrange for
drn,<1kjns and
to direct o?moepnamonc�thpersona �� - -~ '
�c
Signedpossessions have elih&been
removed or may be destroyed, and agree to protect, defend and save harmless Pine Vi,
CreMatorium from any and all alairns and demands for loss or damages which may be r.��i2i'de
against them by r0ason of or connected with the cremation of said remains as directedJw1b,ether
such claims or demands are of,are not wholly groundless, false or fraudulent.
Cobble Hill Road
Ij Lake Placid NY 129A
n 'his_ --'-
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DISPOSITION OF CIRFMATED REMAINS yi f
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i hereby direct mine.View C:rematorklM tO dispose of the Gremated remains as fotlow5: �} i
Mail to
.r
Picked aap by daughter, Barbara Y�1
Other arrangements-pitasespecify-.. 3y �ha ram► NY _ "
if pulverization of cremated remains is requested, check here
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POLICIE-S, RULES AND REGULATION$
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1. The crernatodury) will be open for cremations 5 days a week 7,00 A.M, - 3:30 P,M. KrIpriday-
Friday, No Holidays or Sundays, arrangements can be made frrr Saturday, Prearra,i r Igbments
by telephone for acceptancem of remains is necessary." N
2. Pine View Cremalorium is located on the grounds of the Pine View Cemetery, Quak�r,Road,
Town of Queensbury.
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3. An authorization for crernation properly signed by the nearest next of kin or other�t,Ahcrized
person stating that they do have the power and authority to arrange far the crernatic:ih cif th+.-
remains rAnd to direct the disposition of the cremated remains, that any parsonal p ,ss ons
have either been rernoved or may be destroyed and agree to protect, defend and S, vol
I)armless Pine View Crematorium from any and all claims and demands for loss Or nages
which may be made against their by mason of or connected with the cremation o-Pajd
remains and /or disposition of said remains as directed, whether such claims car det` dads are
or are not wholly groundless, false or trauduient. This authorizalion in addition to a fie'War
bi,trial permit must acc;ornpany the remains-
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4. All remains must be encased in a casket or suitat>le aitmrnate container'. Caskets and
containers n'rust be of corntaustible malerial No Styrofo@m of plastic containers wit, bra
accepted. s,
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5, The goestion relative to cardiac pacemakers rnust be answered on the authorizaf.idi io
crernate form before the remains will he accepted.
6. Unless other arrangements are made the cremated remains wilt be mailed via Regfstbred
Mail within three days of cremation to the funeral home handling the service, Wil am will
be a $2Cr.00 oharge. for this service. i
Cremation, Administration Costs and Recording Fee: Adult$225,00 Children (age '13 n'nths to s"
12. year,) $11,00 infants (stillborn to 12 months) $75,00 !
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Additional $50,DD Charge for cremations clone after 3.01) P.M. Monday through Frida y.
Cre�,rnations dune on Saturdays will be charged the additional $60.00.
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