Cigala, Paul OF QUEEN,5BU9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QLlEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director_ Ali,� ,,nder,
Name �Gvi �
Case#
Dace Of Cremation „ ,,s 20 2007
Time Cremation Started 1; v
Time Cremation Completed 101. 00494
Type of Container Wood �c,3�'pf ZF�= rs' tActg
Remarks
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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:
r( ) (Sex) y/G
(meet) f (City) (State) (zip code)
who died on / day of /441 20 D
at —,�ram' sNo�
(Place) (Address)
Name and address of nearest living relative or name afion:
r( ) V
(Address) 10,
Relationship to the deed
Name of Fund Home
Hoe /) F,CAIAL f�tAJIJC � /�4'f�E e
IMPORTANT:
1 represent that to the best of my knowledge,the deceased or(has no) maker,defibrillator or any other battery operated
device in his or her body. (Clyde One)
I certify that 1 have U power and authorization to arrange for the cremation of the remains and to dined to dsposttion of the
cremated remains,that any personal possessions have ether been rem wed or may be destroyed,and agree to protect,defend and
save harmiesspWoViWipemato W.from any and aM claims and demands for loss or damages which may be made against them
by reason corn the lion of said remains as directed,whether such claims or demands are or are not wholly
grou
fitness) )
w
(Signature and Address Velefive or Legal Repr ive)
Signed on this date:
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mail to
Other arrangements-Please specify:
If pulverization of cremated remains is requested,check here
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. Prior telephone
arrangements for the acceptance of remains are necessary. Prearrangements are
necessary 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 of the cremated remains,that any Personal dons
have either been removed or may be destroyed and agree to protect, defend and save
harmless Pine View Cemetery and Crematorium fscxn any and all,dorms and demands
for loss of damages which may be made against them by r+ 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. A11 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 will be completed within three working days(72 hours)of
receo the
Burial Transmit Permit and Authorization to Cremate Form.The crematedremains will
be mailed via Registered U.S.Mail within three days of cremation to the fumerai home
handling the service unless other arrangements are made:There wilt be a$30.00 for this service. charge
6. Cremation,Administration Costs and Recording Fees:
Adult $325.00
Children (age 13 months to 12 years) $175.00
Infants (stilibom to 1Zs) $125.00
Overtime Cremations(Weekdays) $450.00
Saturday Cremations $450.00