Kendrick, Joseph T07IN OF
PINE VIEW CEMETERYQUEEVBU9�y
AND CREMATORIUM
QUAKER ROAD, Q>EFNSgURY, NEW YORK 12804
(518) 745-4476 (518) 745-4.477
Funeral Director_��
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Dace Of Cremation IU — .20 _ p (.
Time Cremation Started 7;LI 1
Time Cremation Completed 1c, "
Type of Container r sKe � r
C-61 ISr S—
Remarks
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Town of Queensbury
Dine View Cemetery and Crematorium
21 Quaker Road, Queensbury,New York, 12804
Cemetery Office:(518)745-4476, Crematorium: (518) 7454477
Authorization to Cremate
The undersigned rainiest§and authorizes Pine View Crematorium,in accordance with and subject to its Rules and Regulations to
cremate the remains of
__( T
__..- (Street) %Zip Code)
who died on day of D C j. 20 0
at Ut/fLL/N �iErgctr Cf L/{l�E /ALA /D�_—
(Piace) ( >
Name and address of nearest living relative or name of person authorizing cremation:
(Name) (Address)
• RelatibrishiO to"deceased ---
Name of Funeral Home --
2310 Saranac Ave.
IMPORTANT: kr.�,q W;&Wha ►d)pacemaker,�or any other baWy operated
l represent that to the best of my
device in his o'her body. (Circie One)
I certify that 1 have:"power and authorization to arrange for the cremation of the remains and to direct the.disposition of the
cremated remains,That any personal posse dons have either been removed or may be destroyed.and agree to protect,defend and
save harmless We view Crematorium from any and all daims and demands for loss or damages WWII may be made againstt them
by reason of or oonrreded with the t wnetion'of said remains as dueoed,whetter-such claims or demands are or are itot wholly
groundless, Ise or fraudulent.
Z3/c JA' h�,o c A L �PEA c�Jo
7�/�(Witness) (Address)
��/ � LA It _�ci-V
_.. ignature and Addn�ss of Re or Legal Representative)
Signed on this dale:... 0 C I / 7 ZOoI
Dispoe t n of Cremated Rerrmkrs
I hereby direct Pine View Crematorium to dispose of the cremated remains as farlows:
Mail to_ __.._—_— — A.M. Mark.Anc. --
2310 Saranac Ave.
other arrangements-Please spedfy:If pulverization of cremated remains is requested,Check here
Revision:January 1,2006
Policies, Rules and Regulations
1. Pine View Crematorium is located on the grounds of Dine 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 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 aRemate 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 01'Registered U. S. Mail within three days of Cremation to the funeral home
handlirig`the service unless other arrangements are made. There wile 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