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Whitford, Doris rroTtN OF QUEEVBWAY PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director j11 if )Z, Name T0(L� � (.UkVyyOt2 Case# l C) L— Date Of Cremation -7- Time Cremation Started 9 -1 �' ✓w Time Cremation Completed ! 6 `(' Jat-- � Type of Container 'C.-Ax-Jegt-<Ld -4,(, S ,q—�•`, Remarks G — Z C� �'! 1 c� L 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: Doris Whitford Female (Name) (Sex) 11C Swan St. Warrensburg NY 12885 (Street) (City) (State) (Zip Code) who died on 23rd day of February 20 06 at Glens Falls Hospital, Glens Falls, NY (Place) (Address) Name and address of nearest living relative or name of person authorizing cremation: (Name) Tess)) Relationship to the deceased UO-f ^a— Name of Funeral Home Alexander-Baker Funeral Home IMPORTANT: I represent that to the best of my knowledge,the deceased(has s Pro) maker,defibrillator or any other battery operated device in his or her body. (Circle One) I certify that I have 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 fineged m u m any and all claims and demands for loss or damages which may be made against them by reason for c anon of said remains as directed,whether such claims or demands are or are not wholly grpundless (/ Warrensbur NY (Witness) (Address) (Signature and Address of 113616tive or Legal R tive) Signed on this date: Disposition of Cremated Remains I hereby direct Pine View Crematorium to dispose of the cremated remains as follows: Mail to other arrangements-Please specify: Rtn to Alexander-Baker Funeral Home If pulverization of cremated remains is requested,check here XX Revision:January 1,2006 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:OOam 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 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 $30.00 charge for this service. 6. Cremation, Administration Costs and Recording Fees: Adult $325.00 Children (age 13 months to 12 years) $175.00 Infants (stillborn to 12 months) $125.00 Overtime Cremations(Weekdays) $450.00 Saturday Cremations $450.00