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Osterhaud, Howard III TOWN OF QUEENSBURY Pint Virtu Cemetery nitcf Cremn tort utit 21 Qunker Ronri, Queenshury, NY. 12804.5902 (518) 745.4476 (518) 745.4477 htrp Irw\v\v quecnsbury net Funeral Director: 'go 13 Name of Deceased: Case Number: 3 Date of Cremation: — 710 Retort: Q a wl:--0 cz-j Time Cremation Started: ' ! 2, Sr Y+ v _ / Time Cremation Completed: ! 4-/) r fit' Type of Container: ` JN,(Z �CV¢00�) G�Xal- , Remarks: --I/-L. � b r w 10 i r! oiiti nf ' nt : r n I Ben itty .. A Cnnd PIni e to Liur • TOWN OF QUEENSBURY PINE VIEW CEMETERY CREMATORIUM Quaker Road, Queensbury, New York 12804 Phone(518)Crematorium 745-4477(if no answer) Cemetery 745-4476 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: aL (SEX) 4 7 A) k GA� PJ U /V., (STREET) (CITY) (STAY (Zip CODE) who died on 1 1p t k day of SEP:rCM 20 U '/J 0 at (PLACE) (ADDRESS) Name and address of nearest riving relative or name of person authorizing cremation: C.L Relationship to deceased ©�✓ Name of Funeral Home ' I IMPORTANT edge,the deceased as o I represent that to the best of my knowl as o cemaker 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 . ,rematodum from any and all claims and demands for loss or damages which may be made against them by reasons f o v connected t whollyroucremation of false idfraudulent. died,whether such claims or demand / � (WITNESS) (ADDRESS) —" O �-1- f ha J os1l (SIGNATURE OF RELATIVE OR LEG REP.AND ADDRESS) �. . Signed on this date: ` v k a Policies, Rules and Regulations 1. Pine View Crematorium is located on the grounds of Pine View Cemetery. The crematorium operates Monday through Friday from 7:00am to 3:30pm. Prior telephone arrangements for the acceptance of remains are necessary. Prearrangements are necessary for Saturday cremations. 2. A "Authodzatlon 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 remains, 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 remains 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 suitable alternate container. Caskets and containers must be of a combustible material. No styrofoam or plastic containers will be accepted. 4. Cardiac pacemakers, defibrillators or other battery operated devices must be removed before any remains will be accepted. 5. Cremations will be completed within three working days (72 hours) of receipt of the Burial Transmit Permit and Authorization to Cremate Form. The cremated remains will be mailed via Registered U. S. Mail 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 C+vertime Cremations (Weekdays) $400.00 Saturday Cremations $400.00 s A