Wamsley, Corinne PINE YIEW QUEEg�r'5(BUT(-v
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CEMETERY AND CREMATORIUM
QU R ROAD, QUEENS9URY NEW YORK 17804
(518) 745.4476 (518) 745*.4.477
Funeral Director
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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 wWwsarod requests and aumorwes Pure View Crematorium,in a000rdanoe with and subject to its Rules and Regulations to
cremate the ra nains of:
Corinne Wamsley Female
(Name) (Sa)
iC A41 North Creek, NY 12859
(SMN) (Cky) (state) Mp Code)
who died an 30th days April 20 07
at Glens Falls Hospital , Glens Falls , NY
(MM) (Address)
Name and address of nearest living refeave(w name or person aumanzing caremet m:
Priscilla Killon Indian Lake , NY
(Nears) (Address)
Relationship to the deceased D a u g h t e r
Name ofFtnermHome Alexander Funeral Home, Inc. , North River, NY
IMPORTANT:
I represem that to the best of my bwwiedge;the deceased(has)or(has no)peon defibrilaear or any offer bes"operated
device in his a her body. (Circle One)
I cerdfy than I have fuY power and audmizat to arrange for the cxematian of me remains and to direct the disposition of the
cxemated rerrteirrs,that 1 have either been removed or may be destroyed,and agree m protect,defend and
save trermbw CRWWI nrj�
any and aN chins and derrrerrds for loss or damages which may be made against them
by reason Wkh of said rerrnirrs as direck4 whether such calms or demands are or are not wholly
or
Warrensburg, NY
(Address)
Indian Lake , NY
Sigrw�t"and Address of Rekave or Legal Re{rreserrtative)
Signed on Otis dam: 0 5/01/2 0 0 7
Disposition of Cremated Remams
I hereby mect Pine\raw Crematorium to dispose of the cremated remains as follows:
Malt to
omen arrangemeres-Ptease specify: R to to Alexander Funeral 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
c rernatorium operates Monday through Friday from 7:00am to 3:30pm. Prior telephone
arrangemerts for the acceptance of remains are necessary.Prearrangements are
nary 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 ofthe crernaWd 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 diirec:ted,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 win 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 with three days of Cremation to the funeral home
handling the service unless other arrangements are made.There will 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 (stilibom to 12 months) $125.00
Overtime Cremations(Weekdays) $450.00
Saturday Cremations $450.00