McDonald, Stephen 4
TM+N OF QU EEN
.I _y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745'-4477
Funeral Director Ale y46CLtr
,same St1 � (� Case# 3�
Date Of Cremation u�,vst
Time Cremation Started 11.40 Ah
Time Cremation Completed
Type of Container C(b+L (4!,4f ud Mp CA-SC
Remarks
11- 90 4l'1 I'1UvE �2,3� Ph
<'Jo'' 1-co QrI
37�j
Town of Quawabury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury,New YO[k, 12804
Cemetery Office_(518)745-4475,Crematorium:(518)745-4477
Authorization W C►eMate
The wWwsigned regttests w d aultt xtms Ptne 1Aew am"km w eccarrftm with and subject to Its Was and Regulations to
cremate the remains of:
Stephen H. McDonald Male
(Name) (S")
809 Glen Athol Rd. , Warrensburg, NY 12885
(Street) (Cky) (state) (Zip Code)
who died on 22 dy of Aug. 2fi 07
at Glens Falls Hos .
(glace) (Address)
Name and address of nearest Crvhg relative or none of person autharian8 cremation:
Zina McDonald Sameeas above
(Name) (Address)
Relationship to the deceased W i f e
NameotiztwwwHorne Alexander-Baker FH, Warrensburg, NY
IMPORTANT:
I represent tat to the best of my Wwwledp,the deceased &(w no)facemalw,defrbtSator,battery,battery px.poww
cell,radioecve implant or radioactive device in his or her body.(Clyde One)
I cerWy that I have tuft power and aufhorbsOon w a im for ttte c wnotlon of fhe rBlnft and to dw fhe disposkion of the
cremated remain no any e ors tove ellher been nweved or may to desliroya4 and apse to proms,defend and
save t>armies I Pk-*APeii:GSnematori m any and ad chins and demands for loss or which may be made apai!>st them
by reason a nrhected cremation of said remains as dkeeled,whether such claimsor demands are or are not wholly
,false or
arrensbur NY
(WRness) (Address)
X o,,� Same as above
(S'ignat"and Address of Retetive or Legal PApresentative)
signed on this date: 8-2 3-0 7
tAIsposition of Cremated Remains
hereby direct Pine View Cretnforium to dispose of the cremated remains as fo&wms
Mail to
Omer arranwments-Please specW. F H will pick u p
If Mdmrfmtion of cYerrrated remains is mqueOed,d*Ck here `
Revision:ApM 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 7:009m to 3:30pm. Prior telephone
arrangements for the acceptance of remains are necessary. Prearrangements are
necessary for overtime or Saturday cremations.
2. A `Authorization 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 pa-essions
have either been removed or may be destroyed and agree to protect,defend and save
harmless Pine View Cemetery and Crematorium from any and an 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 disposAm of said remains as directed,whhe#wr
such claims are, or are not wtoNy groundless,false or fraudulent.This authorization in
addition to a regular burial permit must accompany the remains.
3. All remains must be in a casks or suitable akernate container. Caskets and containers
must be of a combustible material.No styrofoarn or plastic c otminers wltl be accepted.
4. Any Cardiac pamnakers,dM&NIators,battery,battery pack,power veil, radioactive
implant or radwec ice device must be removed from the body before any remains will be
accepted.
5. Cremations wig be compheted within three worldng days(72 hours)of receipt of the
Burial Transmit Permit and Authorisation to Cremate Form.The cremated remains will
be mailed via Registered U.S.Mad within Uvae days of a emation to the ft wW acme
handling the service unless o#w arrangements are made.There vrnl be a$30.00 charge
for this service.
6. Cremation,AdmintsUaton Costs wW Recording Fees:
Adult $330.00
Children (age 13 months to 12 years) $180.00
lnfanis (stillborn to 12 months) $130.00
Overtime Cremations(Weekdays) $480.00
Saturday Cremations $480.00