Hatch, Eleanor TOrMN OF
QUEEN5B` Pr/
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Name
Funeral Director P
L,
PG no!� l eii+a r—
Case# �GL
Date of Cremation O�
Time Cremation Started
z .
Time Cremation Completed
Type of Container �GG in C
1
Remarks
Novi! = s
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 yew Crematorium,in accordance with and subject to its Rules and Regulations to
cremate the remains of:
Eleanor Hatch Female
- {Name) ( )
124 Marcy Lane, Newcomb, NY 12852
(street) (City) (State)
��14th p Code)
who died on day of Nov. 06
20
at Glens Falls Hospital
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremation:
Dexter C. Hatch (same as above)
(Name) (Address)
Relationship to the deed Spouse
Name of Funeral Home Al Pxand - FH, Inc, North-River, NY
IMPORTANT.
I represent that to the best of my knowledge,the deceased(lJ)Wbr(has no)pacemaker,defibrillator or any other battery operated
device in his or her body. (Cirde one)
I certify that i have full power and suthorbn im to arrange for the cremation of the remains and to direct the cfiSposition of the
cremated remairm that possessions have either been reffurved or may be destroyed,ar+d agree to protract,defend and
save harrress ri mine lLery from any and all cans and demands for loss or damages which may be made against them
by reason of orcailinected FtheernahOn of said remains as directed,whether such claims or demands are or are not wholly
groin or lent.
Warrens urg, NY
�) (Address)
X ame as above
signa andture A ess of Re&vwe or Legal Representauve)
Signed on this date: 11-15-06
Disposition of Cremated Remains
I hereby direct pine View CremaMum to dispose of the cremated rnrnains as follows:
Mail to
Other arrangements-Please specify: FH will 1 1 pick up
if pulverization of cremated remains is requested,check here X
Revision:January 1,2W6
Policies, Rules and Regulations
1. Pine View Crematorium is located on the grounds of Pine View Cemetery. The
crematorium operates Monday through Friday from 7:008m to 3-
arrangements for the acceptance of remains are -� . Prior telephone
necessary for Saturday cremations. �•Pr ananc3ements are
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 disposftion of the awu t+ad remains,that
have either been removed or may be d and �y Pal possessions
harmless Pine V�Cenlete y and Csemat�um#ror�nee to protect, defend and save
for loss of damages which may be made �and all claims and demands
ttte cremation of said remains and/or d' ��them by reason of or connected with
such claims are,or are not who!] ���of��remains as directed, whether
addition to a regular burial y groundless,fa'se or fraudulent.T�a�orization in
permit must accompany the remains.
3. JU rsamains must be tin 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 tract
ery
before any remains will be accepted. operated devices must be removed
5. Cremations will be completed within three world
Burial Transmit Permit and Authorization to ��C72 hours]of receipt of the
be mailed via Registered U. S. Mail within three days Cremate of cremationForm•The cremated remains wilt
handling the service unless 0#W amw to the funeral home
for this service. 9 s are
made.There will be,a$30.00 charge
6. Cremation,Administration Costs and Recording Fees:
Adult $325.00
Children (age 13 months to 12 years) $175.00
Infants (stillborn to 1Z:mor►ths) $125.00
Overtime Cremations(Weekdays) $450.00
Saturday Cremations $450.00