Sullivan, Helen OF UE�
Q 9�SB U 2r
PLNE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY NEW YORK 12804
(518) 745-4476 (518) 745.-4477
Name
Funeral Director e'.a
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Dace Of Cremation
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Time Cremation Started
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Time Cremation Comple�ed Z ' J�
Type of Container c,rc ocild �—
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Remarks
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Cwtetaary C fkw-(518)745a4476.Q emaU (5181745-4477
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Th8 UrtdtltSWed MgUe Wid 8t MWtaeS t� OMMOMM in +fft SW to fls Figs and Regulelkm to
awasiethereamirisof
Helen J. Sullivan Female
(4wM) (Cx)
'3'67 (&mr tfv— Q("u,4 Pot-1r All / gaq
(Street) (CRY) (State) — (ZIP Cie)
whodiadon 14th day t October 20 07
ar Glens Falls Hospital
( ) ( )
Name and address of nearest rig relative or rearms of person,s dxxb ng cremation:
/3+%&y1A /rMNoutA FI; 5-83 0 /kt23u 7u s ;WAIL rAy979vt"t, - ^/C 7t 3 i
(Name) (ad�ees)
ReWon*dp to the deceased OWN 6IOUL
Alexander-Baker Funeral Home
IMMRTANT:
1 represent OW to"test of agr kw#Aedg%ihD rim 0oaeed(toes)or om ne)peoettiaicer.dtfteatar,may, Pads,P&*W
cell,radioactive implant or radoactive device to his or her body-(Cede Om)
I certify that 1 have ful power sstd tflarrmtgstrthematalitieramantitodirectthe ofthe
Cremated.remakm th+ t: train 1 W beef tarltac all Q=W be dmMvj cis ant agree to(tarsal,detertd end
save helm it; (;.tParriti�cll errs and ad chhm and Iaomtd 1 far toes er dam t fth stag►be made against there
by or conrwcwd vAb ee crams n of sdd rem tm wed,w sLch daints or demande are or are not wholly
fedse or St.
(Signam and Address of Reledve or Legal FU*wsenW0re)
Signed on this date:
tton of Cremated Remains
hereby deed Piste!View C remialiocir ate to dispose of the ciarrretad remakes as to me:
Mail to
Owes ei rwQamaM-Pieria Spadfy rl'� (AAC4 r4i U t7
if psi wbation of arameW remains is mWested,awes here
Rtavi m-.Apti119.2D97
Policies, Rules and Regulations
1. Pine View Crematorium is located an the grounils of Pine View Cemetery.The
crematorium operates Monday through Friday fr m 7:t)0am to 3:30pm. Prior teleFtmne
arrarigemwmts for the acceptwxe of renuhn are necessary.Peearrangements are
necessary for overtime or Sah day cremations-
2- A OAuduxizedon to Cremate'horn signed by the rarest ne)d of kin is necessary stating
that they do have the psi and auft*to arrange for the cremation of the remains
and to direct the disposition of the cremated rerrakvs,that any personal possessions
have either been removed or may b3 deMoM and agree to per,Ord and saw
ham-dew Pine View Cemetery and 1 2m I ont arty and 61 claims and demands
for toss of damages which may be made it by reason of or connected with
the cremation of said ren 09posbon of smd remains as directed,der
such claims are,or are riot wholly grourn2ears,lobe or ftudulem This ataxx zatiort in
addition to a regular burial pe;t*must accompany the remains,
3. All remains must be in a casket or stAmdAe alierriwe ems.{:asicets and contairms
must be of a combustible ram.No slymfmn or i�v svM be aax pW.
4. Any cardiac A k .deftMatms,battery.wry pack.poor cell, radioactive
Implant or rad'Mactha.device must be rid fiom the body before any remains will be
accepted.
5. Cr+ernaftns will be cwoeWd witImto-ee w (72 hms)of apt of the
Burial Transact 1?emiit and^11hoirimadw 10 Crime Form.The cued remains will
be mailed via Rego U.S. Mall tot ftm days of ID OW ftmad howls
handling the service tmtw t *A r MIMzMM9db.ThmwMbea$30.WchaW
for this service.
6. 'DeMatim,Atgr3inlsVat m Costs and ReoorMV Fees.
Adult $3W.W
CWidren (age 13 months to 12 years) $18M00
infants (Stillborn to 12 rr ) $130.00
Overtime Crwatim(Wdekdays) $480.00
Saturday cremations $480.00