Allison, Esther �O O
PINE VIEW CEMETERY
QV'A� ROAD, CREMATORIUM Q�MENS9URY, NHW YORK 128Q4
(518) 745.4.476 (518) 745.4477
�'�neral Director
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Crier
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Town of Queensbury+
Pine View Cam►and Crenumdum
21 Quaker Road.Queensbury,New York, 12804
Cemetery Office:(518)745 4476,Crematorium:(518)745-4477
Authorization ID Cremate
The widwSIPW mgwm erd atdhorlmes Pate View Atrfrte m m,in ammdence v tt and subject to its Rules and Reg&Mons to
Cremate the remains of.
Esther Allison Female
(Nara) {sex)
556 Bird Pond Rd. , North Creek,NY 12853
(st ) (may) (state) (Zip Code)
whodedcn 18th days July 20 07
at Adr. Tri-Co. Nursing Home, North Creek, NY
(place) O
Name and address of nearest fivkV reled+re or narne of person aLdxw ming cremation:
Samuel Allison, 564 Bird Pond Rd. , North Creek, NY
( ) (Address) ._
Rekoonship to the deceased S o n
NameotFunwalHome_ Alexander FH, Inc, North River , NY
IMPORTANT:
I relxesent that to the best of rry Wxwvledge,the deowsed QMX Mas no)paoernaicer,delldraator,battery,battery pack,power
cell,radioactive implant or radioactive device in his or her body.(Cttde one)
I oe*that 1 have M pott►er and lion to MMM for"amolkin of Ste raindris and to&W the dlsposii bn of the
cxeffaw ren 1rts,that ar g ors anions have eMw been imr" 0 or nt�r be desboyedi,and agree to poled,defend and
save harmless P from arty and a8 deims and duds for loos or damages wtidt may be made agown them
by reason , cnwnaWn of said remains as dttaded,whetter auch deltas or demands are or are not wholly
fidseor
Warrensburg, NY
M► ) (Addres)
` Same as above
(swam"andRelative a Legal Rom)
Sinned on this crate: 7-1�8=0 7
rilion of Cremated Remains
hereby direct Pine View Cmywwrkjm to dispose of the cremated remains as follows:
Mail to
other anangernents-Please spew. F H w l 11 pick up
If Wvenzation of cremated n meets is requested,check hem X
Revision:April 18,2007
Policies, Rules and Regulations
1. Pine View Crematorium is looted on the grounds of Pine view Cemetery.The
crematorium operates Monday through Friday from 7:OOam to 3:30pm. Prior telephone
arrangements for the acoeptaroe of remains are necessary.Prearrangements are
necessary for overtime or Saturday cremations.
2. A 'Authorization to Cremate'form signed by to 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 rerrwv+ed or may be desVoyed and ag"to protecL defend and save
harmless Pine View Cemetery and Crerr8rxium from any and all dams and demands
for loss of damages which may be made agairist them by mason 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,fi�be or fraudtdient.Tht authorization in
addition to a regular burial permit must accompany the remains.
3. All remains must be in a casket or suitable alternate comer. Caskets and eorrtainers
must be of a Combustible material.No styroloam or phWk eorgaineis win be accepted.
4. Any cardiac pacemakers,dMriilfors, battery, battery pack,poorer cell, radioactive
implant or radxxx#m device ffwst be removred from the body before any remains will be
accepted.
5- Crerrmadons will be completed w three workft days(72 hours)of receipt of the
Burial Transmit Permit artd AtRhorizedon to Cn M09 Form.The cremated remains will
be mailed via Rq#sterW U.S. Mal within three days of am lfion to the fimerd have
handling the service unless other arrangements are Rom,There will be a$30.00 dmW
for this service.
6. Cremation,Adminwration Costs and Recording Fees:
Adult $330.00
Children (age 13 months to 12 years) $180.00
Wants (stillbom to 12 months) $130.00
Overtime Cremations(Weekdays) $480.00
Saturday cremations $480.00