Chonko, Stephen TO 7+N OF QUEE9�5BU��y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD. QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director / � cyan �(�,!
Fame S`te� en C�vJ�k 0 C a s e# {� 7
Dace Of Cremation
Time Cremation Started
Time Cremation Completed AM
Type of Container
SAS
Remarks
Ma v 'd ' i U A
3d
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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)745-4477
Authorization to Cremate
The undersigned requests and authorizes Pine View Crematorium,in accordance with and subject to its Rules and Regulations to
cremate the remains of:
Stephen Chonko Male
(Name) (Sex)
128 William J. Baker Rd. , Warrensburg (T/0 Thurman) , NY 12885
(Street) (City) (State) (Zip Code)
who died on 2 0 t h days December 20 06
at 128 William J. Baker Rd. , T/0 Thurman
(Place) (Address)
Name and address of nearest living relative or name of person authorbft cremation:
George Chonko, Thurman, NY
(Name) (Address)
Relationship to the deceased S o n
NameofFuneraiHome Alexander-Baker Funeral Home
IMPORTANT:
I represent that to the best of my knowledge,the deceased(has)or(has no)pacemaker,defibrillator or any other battery operated
device in his or her body. (Circe One)
I certify that t have full power and auttwi¢atiorr to arrange for the cremation of the nernak s and to direct the disposition of the
cremated remains,that ar�t�e Ep,
ss�orrs have edw been rerroved or may be destroyed,arid,agree to pr�otecx,defend and
save kharrrrless few Cie from any and all cairns and demand&kw loss or damages which may be made age them
7't
nnected the rrakmMn of said remains as directed,whether such claims or demands are or are not wholly
or
Warrensburg, NY
(Wilness) (Address)
Z---___TF_u—rman, NY
IfAgnae and ress of Relative or Legal Representative)
Signed o this date: 12/21/2 0 0 6
Disposition of Cremated Remains
1 hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mail to
Other arrangements-Please specify: R t n to Alexander-Baker Fun e r a l Home
If pulverization of cremated remains is requested,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. Prig-telephone
arrangements for the acceptance of remains are necessary. Prearangements are
necessary for Saturday cremations.
2. A "Authorization for Cremation'signed that they do have the power and authori by the nearest next of kin is necessary ty to arrange for the cremation of thremains
ng
and to direct the disposition of the a�errrated remains,that any personal
have either been removed or may be destroyedmoons
harmless P{ne View Cemetery and agree to protect,defend and save
and Crematorium#scan any and all dalms and demands
for loss of damages which may be made against them by reason of or wed with
the cremation of said remains and/or disposition of said remains as directed,whether
such claims are, or are not wholly groundless,fad or fraudulent. This a addition to a regular burial permit must accOm uthorizatiort in
parry the remains.
3. All remains must be in a
must be of a canbusti casket or suitable alternate container.Caskets and containers
ble 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 via Registered U.S.Mail within three days of cremation to the funeral home
handling the service unless other arrangements are made.There will be a$3 al urge
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.nad4s) $125.00
Overtime Cremations(Weekdays) $450.00
Saturday Cremations $450 00