Wagg, Frederick �F
TO rPIN OF QUEENs5BU9�y
PUVE VIEWCEMETE
CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW PORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director A1
pp �n r
Name ..
�tcierlCk, 4
Case# '-15 3
Dace Of Cremation IA
Time Cremation Started
1" S
Time Cremation Completed
I : pd
Type of Container Remarks
`j=1g P7
Ib M
(a-U0
iO �p
h
�� , � 7
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 audxxizes tine Vwe v Crematorium,in accordance with and subject to its Rules and Regulations to
cremate the remains of
Frederick G. Wagg Male
(Name)
119 Hudson St. , Warrensburg, NY 12885
(street)
1 0 t h (state) (Zip Code)
who died on clay Of Oct _20- 06
at Glens falls Hospital
(Place) (Address)
Name and address of nearest living relative or name of person auth
orizing cremation:
Sherry D. Wagg (same as above)
(Name) (Address)
Relationship to the deced S p o u s e _
Name of Funeral Home—Al exander-Baker FH, Warrensburg, NY
IMPORTANT:
I represent that to the hest of my ivtowiedge,the deceased 5'J Xr(has no)paoamaker,defitxiitator or any other battery operated
device in his or her body- (Circle One)
1 certify that t have f
tf_tom 4Rd art to for the cnmmd n of the remains and to direct the of the
cremated rertta a ersonat poss8sskwn have either been removed or may besave harm ritlttt rom destroyed,and� protect,defend and
�aid�maims aid de►rtenr��lOss ordamages may b b e made against them
rea or l with the cremation of said remains as detected,whether such claims or demands are or are not wholly
9rou or fraudulent
Warrensburg, NY
(Witness) (Address)
Same as above
(SWat&e and Address of Relat" etxesentative)
signed on this date: 10-6-0 6
Disposition of Cremated Remains
!hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Maii to
Other arrangements-Please specify: F H will pick up
If pulverization of cremated remains is requested,check here X
Revision:January 1.2DD6
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 "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 Cearetwy and Cfemat-cxium frcffst any and al1.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 femains must be sn a caskdet cx suitable alternale 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 wM be completed within three working days(72 hours)of receipt of the
Burial Transmit Permit and I°uathorizawn to Cute 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 arrangenmuft are made.ire wilt 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-inonths) $125.00
Overtime Cremations(Weekdays) $450.00
Saturday Cremations $450 00