Benoit, Ronald (7-O%N OF QUEEVBU9�
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
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Funeral Director ,rots (1cr
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Date Of Cremation 10 - N- 05,
Time Cremation Started q . 06
Time Cremation Completed (l= 36 �¢ M
Type of Container to tire
Remarks
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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.
Ronald J. Benoit Male
(NAME) (SEX)
18 Owens Rd. , Minerva, NY 12851
(STREET) (CITY) (STATE) (Z E) '
who died on 30th day of Sept. 20 O�
at 18 Owens Rd. , Minerva, NY 12851
(PLACE) (ADDRESS) 7-
Name and address of nearest living relative or name of person authorizing cremation:
Alyce Benoit (same as above)
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Relationship to deceased Spouse
Name of Funeral Home Alexander-Baker FH, Warrensburg, NY
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IMPORTANT
I represent that to the best of my knowledge, the deceased Kr has no pacemaker in his or her
body. (CIRCLE ONE)
I certify that I have the full power and authorization to arrange for the cremation of. „�emaj s and
to direct the disposition of the cremated remains,that any personal possessions aillber uieba, `
removed or may be destroyed,and agree to protect,defend and save hamdess
Cremation any and all claims and demands for loss or damages which may be
a em reason of or connected with the cremation of said remains as ducted,wHettter
ch dal or demands are or are not wholly groundless, false or fraudident.
Same as above
Sf ATURE O RELATIVE OR LEGAL REP. AND ADDRESS)
Signed onftiis date: 10-3-0 5
I
^ISPOS1TiON OF CREMATED REMAINS
I hereby direct Pine View Crematorium tr dispose of the cremated remains as follows:
Mail to
Other arrangements-please specify:
If pulverization of cremated 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-
Fri jay. No Holidays or Sundays, arrangements can be made for Saturday. Pre-arrangements
byTelep,hone for acceptance of remains is necessary.*
2.- ..p' rematorium is located on the grounds of the Pine View Cemetery, Quaker Road,
eensbury.
3. An., on for cremation properly signed by the nearest next of kin or other authorized
person stating that they do have the^owar and authority to arrange for the cremation of the
remains and to direct the dispositi- of the cremated remains, that any personal possessions
have either been removed or nray p destroyed and agree to protect, defend and save
harmless Pine View Crematorium ' `t any and all claims and demands for loss or damages
which may be made against them uy rcason of or connected with the cremation of said
remains and/or disposition of said remains as directed, whether such claims or demands are,
ort`ere 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. 'The question relative to cardiac pacemakers must be answered on the authorization to
cremate form before the remains will:be accepted.
6.. .Unless otl,�' ngements are made the cremated remains will be mailed via Registered
S,Mai!within three days of cremation to the funeral home handling the service. There will
&a$25.00 charge for this service.
Cremation.Adminigttatidn Costs and Recording Fee: Adult$300.00 Children(age 13 months to
12 years)$150.00. Infardw(SWItpm to 12 months) $100.00
AdditionV.- aturdays,
aarge for cremations done after 3:00 P.M. Monday through Friday.
Cremation will be charged the additional$50.00,