Lanfear, Craig O J QUE(Eg\�S(-BUT-T
PINE SEW CEMETERY AND CREM
QUAKER ROAD, QUEENSBURY, UM
NEW AT AT 12ORI
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(518) 745 4476 804
(518) 745'•4477
Funeral Director
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Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury,New York, 12804
Cemetery Offive:(518)745-4476,Crematorium:(518)745-4477
Authorization to Cremate
The undwsigned requests and aulhortass Pk*View Cram,In acmdence with and subject to its Rules and Regulations to
cremate the remains of
Crain Lanfear Male
(Name) _—... Fes) _
(SUW) (CRY) (State) (Zip Code)
who died on 2 0 th day of June 20 0 7
atRt. 418, Stony Creek, NY 12878
( ) (Address)
Name and address of nearest WAN relative or name of person au#xwbwg cremation:
Valerie Lanfear, tS4 -,-?i/iR/J vf'
(Name) (Address)
Relationship to the deceased ';D O 1 S P
NameofFuwwHonne Al exander-Baker FH, Warrensburg, NY
IMPORTANT:
I represent that to the best of my Wvwledge,the deceased OKor(has no)pacemaker,delibrilMor,battery,battery peck,power
cep,radioactive implant or radioactive device In his or her body.(Circle One)
I certify do I have AM power ant authorization to wrange for the cremation of the remains and to direct the disposition of the
cremated renwos,Ova any persorrel ions have either been removed or may be destroyed,and agree to protect,defend and
save harmless Pine View arty and ell cairns and demands for km or damages which may be made against them
by reason of or with cremation of said remains as directed,whether such claim or derrrarrds are or are not wholly
groundless, or
Warrensburg, NY
ftnew (Address)
Same as above
(Signs�Addpgssative or Legal Representative)
Signed on this date: 6-21-0 7
Disposition of Cremated Remains
I hereby direct Pine View C rernatorkmr to dispose of the cremated remains as foitows:
Map to
Other arrangements-Please specify:__ F H w 111 pick up
If pcdvermation of cremated remains is requested.check here X
Revision:April 18,2007
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 overtime or Saturday cremations.
2. A 'Authonzatioon to Cremate'form 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
harrmiess 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 altemate container.Caskets and containers
must be of a combustible material.No styrotoam or plastic containers will be accepted.
4. Any awdiac pacemakers,de"Wtots, battery, fiery per, per cell, radioactive
implant or radioactive device must be removed from the body 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 hxx al home
handling the service unless other arrangements are made.'These will be a$30.00 charge
for this service.
6. Cremation,Administration Costs and Recording Fees:
Adult $330.00
Children (age 13 months to 12 years) $180.00
lnfarns (stillbom to 12 months) $130.00
Overtime Cremations(Weekdays) $480.00
Saturday Cremations $480.00