Putnam, Karen 0.
OF QUEENS `Z 1,�
PINE 'VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, Qt1EENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director A����,�,����
Fame KCMIn �vtntivr�
Case#
Dace Of Cremation GL
Time Cremation Started 1 ;
Time Cremation Completed 10: eo A
Type of Container ��tc��
c, w I.vc�vd LF E l ST C�,S�=
Remarks
1i�) 35
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Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office:(518)'345-4475, Crematorium: (518)745-4477
Authorization to Cremate
The undersigned rettuests and authorizes�View Crematorium.in accordance with aft� to its Rules and Regulations to
cremate the remains
Karen Lee Putnam Female
(Name) (Sex}
785 Diamond Point Rd. , Town of Lake George ,Diamond Pt. , NY 12824
(Street) (City) {State)
20th �'p code)
who dayof December 2006
at Glens Falls -Hospital , Glens Falls , NY
(Plam) (Address)
Name and address of nearest living relative or name of person authorizing cremation:
Slyvia Putnam, Diamond Point, NY
(Name) (Address)
Relationship to the deceased Mother
Name ofFunermHome Alexander-Baker Funeral Home
IMPORTANT:
I represent that to the best( 1W,the deceased(has)
Or(has no)pacemaker defibrillator or any other flattery operated
device in his or her )
1 certify that i have"power and a'Ahorka"M to orange for the creeneflan Of the nemtdms and to drec the desposWon of the
cremated remains,that any Personal Pons have either been agree to
save harmless Pine Yew ft m any and ail daims and dernands for toss or dwk-Ajm ackf Pam.defend and
by reason of or t � caetnation of said fefWMS as directed,whether such do or erawhic dray t]e made against them
groundlem latse or haucfulent: demands are or are not wholly
....::
(Witness)
Diamond Point , NY
Vignature and Address of Relative of t egal Representative)
Signed on this date: 12/21/2 0 0 6
Disposition of Cremated Remains
I Weby direct PkV Vff-wr Crenw#W m to dtspose of the cremated remains as folkwvs:
Mail to
other arrangements-Please spec ity: R t n to Alexander Funeral Home
If pulverization of cremated remains is reed,check here X
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.!'re3n'8ngements 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 m.that anyam!P P�ssivns
have either been removed or may be destroyed and agree to protect,defend and save
harmless Piste View Cemetery anti Crematorium from any and all claims and demands
for loss of damages which may be made against them by reason of or connected the cremation of said remains and/or d' with
such claims are, or are not whollyisposrhon of said remains as directed, whether
addition to a regular burial permit must ac com mjkxM false h fraudu�L This authorization in
i�YY thin remains.
3_ All Temmust
be its must be in a casket or
al suitabie alt�te 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 Woddng Burial Transmit Permit andYs(72 hours}of receipt of the
�tithion t Cremate Form.-�cremated remains will
be mailed via Registered U. S. Mail within three day$of remotion to the
handling the service unless other funeral home
for this service, arrangements 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 12-Months) $125.00
Overtime Cremations(weekdays) $450.00
Saturday Cremations $450,00