Dramm, Herbert 2�O�v OF QUEEN,5BU-(�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director_ ti CLkRt'
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Time Cremation Completed
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Remarks
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Town of Queensbury
pine View Cemetery and Crematorium
21 Quaker Road, Queensbury,New York, 12804
Cemetery Office;(518)745-4476, Crematorium: (518) 7454477
Authorization to Cremate
red r" and authorizes Pine View Crematorium,in accordance with and s to its Rules and RbguEattons to
The undersi9�� ei�+iest�
cremate the remains of:
-------W_
(sex)
(Street) (C'
who died on __�:�•+� day ofT 2Q oG
(f,lace). {Aridness)
Name and address of nearest riving reletive or name of person audxx'zing cremation:
µ (Address) A'/12 P Vd
(Name
Relationsb)jf to iti deemed
41 11. (A1ttrk.Inc.
Name of Funeral Home___._ -—. 2310 Saranac Ave.
d the deceased( Lak Plac d NY 12 uatar or any other bell"operated
1 represent that to the best of my knowledge, has)or P ars
device In his or her body. (CUcie One)
• I certify that I hwe:fop power and.authorizetfon to arrange far the drernetion of the remains and to�d�Wed�ta of defend and
cremated remains.that any personal possessions have either been removed a may WNch may be made agait►st them
save harmless pine VWAj Crarrtetodum fnitn any and all dams and demands for loss or damages
by reason of connected with the rnaiiortof said remains as d1tWed,whatftLN such Balms a demands ere a we trot wholly
groundless,fal,�,or fividulent. j1G.S. (Hark.Inc.
Lak PPRM, Y 12946
1/�. LA�C�y �29YG
afore d or Lao Representative)
Signed on this dale:
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as fdlows:
Mail to
9Il.M.Thick.Inc. ----
_^ -` I$8VG7
Lake Placid, NY 12946 —�- ___._.---T -- •---
other arrangements-Please specify:— -- —.-- —___ —
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 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 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 VIO,Registered U. S. Mail within three days of tremation to the funeral home
handlit O'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