Bodenweiser, Nicholas k'.
TOrMN OF
QUEE�BUP
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director_��
Fame
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Case#
Date Of Cremation o�
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Time Cremation Started
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Time Cremation Completed �; p
Type of Container tidto r� E 15T
Remarks cA 5
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Town Of Queens"
Pine View Cemetery and Crerriatmium
21 Quaker Road,Queensbury,New York, 12804
Cemetery Office:(518)745-4476,Crerrmtorium:(518)745.4477
Authorization to Cremate
The undersigned requests and wAmImes Pkw View Cmmato*".M a000rdanCe with 04 subjed to its Rules and Regulations to
awnew the remains Of:
Nicholas A. Bodenweiser M
(Name) (Sex)
86 Alden Ave. Warrensburg NY 12885
(Sheet) (Cky) (State) (Zip Code)
whodiedon 8/7/2007 day of August 20 07
at Glens Falls Hospital
O O
Name and address of nearest fiving;relative or name of person authorizing cremation:
(Name) (Address)
Relationship to the deceased
Nameofl=uneraiHome Alexander Funeral Home (Warrensburg)
IMPORTMIT:
I represers that to the best of my knowledge,the deceased(has)or(tree no)pacemaker,defibrillator,battery,battery per,pow
cell,radioactive implant or radioactive deice In his w her body-(Clr+de one)
I ced ly that I trove ftgl power and au#wrastion to amarrge for fire rim-r 8ort of the retrrakrs and to cfi w the diSposition of the
cremated rem ,that cal poeseseiotts trerre eitrer been rer kwW or may be destroye4 and agree to protect,defend and
am
save hermiess from any and as claims and derearr Is for loos or damages vd*h may be nede against there
by or con with the cremation of said remake as dreefed,whWw such cleirm w demands are or are riot wholly
,false
X
{ and of Relative C. RepreSerNstiVe)
Sued on this date:
L&Mosibon of cremated Remains
hereby died Pine View Crenvaorkim to dispose of the cremated remains as foito",
Matt to
other arrangements-Please speW. Funeral Home will pick up.
if putvww#ion of cremated mmem is requested,check two
Revision:April 18,2007
Policies, Rules and Regulations
1. Pine View Crematorium is located on the grourxls of Pine V-ww Cemetery.The
crematorium operates Monday through Friday from 71ftm to 3:30pm. Prior telephone
arrangements for the acne of remains are necessary. Prearrangements are
necessary for overtime or Saturday cremations.
2. A 'Authorization to Cremate'form signed by the nearest ne)d of kin is necessary stating
that they do have the power and air to arrange for the cremation of the remains
and to direct the disposition of the cremated remakts,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 frexn any and all claims and demands
for loss of damages which may be made against them by iron of or connected with
the cremation of said remains andfor disposition of said remaints as directed,whether
such claims are,or are not wholly groundhms,fuse or*audtUenL This authorization in
addition to a regular burial permit must accompany the remains.
3. All remains must be in a casket or sure alternate con . Caskets and containers
must be of a combush'ble material.No styrokam or Pkisfic cocrfainers wilt be wed.
4. Any cardiac pacemakers,deffixillators,battery,battery paw power cell, radioactive
implant or radioamw dsvice must be removed from the body before any remains will be
wed.
5. Creffiations wig be wed w d-An three worimig days(72 hours)of receipt of the
Burial Transmit Penns;and Auhorization to CrernM Form.The cremated remains will
be mailed via Registered U.S. Mal WRW three days of aerregm to the itxierW home
handling the service unless other arrangerrents are crude.There wtii be a$30.00 charge
for this service.
6. Crematiai,AdminisUadon Costs and ReODfft lam:
Adult
Children (age 13 months to 12 years) $180.00
Infants (stillborn to 12 months) $130.00
Overtime Cremations(Weekdays) $480.00
Satuixlay Cremations $480.00