Matteau, Raymond OF
QUEE9 5B U Ky
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, Q(jEENSgURy, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director f��fr�a►.d(4
Name °�`�mow� enu
Case#
Dace Of Cremation
r'rnmlxr ,v Z0
Time Cremation Started
Time Cremation Completed ,S'� � � P,
Type of Container Car �4q,rd 21v
Remarks D C
`S, �I
Town of Quemsix"
Pine View Cerny and Cerium
21 Qmker Road,Queer,New York, 12804
Cetne"Offim:(518)745"478.CmtrtaWtarit_(518)7454477
Atdho n ix)Cnunate
The tltfdm*v d mmAlm eM ma ulms Pine Ww QemmMxn.In eanftwevft ffd w4act to es Resins and Reptaftm to
cremate the remafrhs of:
Raymond F. Matteau Male
Oft") (sett)
3 S'Z- /"14 S7 Warrensburg NY 12885
( ) (fir) (swe) (Zip Code)
who dW-on 6th dayot December 20 07
at Glens Falls Hospital
(Place) (Addrew)
Name and address of nearest env native or nm m of person asr;honm g creinewr:
Anita Matteau ; (4ay-v
(frame) (Address)
Re►wonsmp to tthe deoeesed W i f e
N3n*wFtaheraffianh8 Alexander-Baker Funeral Home
IMPORTANT:
I re resent that to the best of my imowfedge,the d (has)or[m no)pacemakw.deftwales,may,bwtw]r par,pow
cell,radioer know*or nxNwc"deride In his or heir body.(Cirde Qne)
I certify that 1 haKe and aLdwrkwdm tQ stamp for On of On mmeft and to OW ft ffsposMn of the
cxemated Tarns! rfhat y persona!p ftwe t I m m rep DYW or mW be desb oyed aad agree to protect defend and
us= F *S-'- j cfe e d 7 m v n ddes twinsortlenroad+ideoWbe deaigek"adlem
lvp-.._ n a SEzd c a as d�lected. Tartu c tftm or 1 are or ate rest vdv
false or
(Sofa m ad Address of fie or Legs!PA pro re)
Skpwd onMisdaW December 7 , 2007
Uleposi ion of Cremated Rerw"
I hereby dined Pine View Qemakxiurn to dispose of the cnmuftd ra mins as follows:
Mad to
Ober anangranerft-Please spec W- C-( w r I.i r�r C�( ✓�
If puivervstion of crerreal ed remains is requested,Check here _
Reviclom April 13,2DO7
Policies, Rules and Regulates
1. Pine View Crematorium is kxNftd on the grounds of Pirm View Cemetery.The
crematorium operates Monday through Friday from 71Oam to 3:30pm. Prior telephone
arraa for the aloe of renv*ws are necessary.Prearrangements are
necessary for overtime or Saturday cremations.
2. A 'Authorization to Cremate'form signed by the nearest need of kin is necessary stating
that they do have the power and authority to arrange 1br the cremation of the remains
and to direct the disposilion of the cremated ram,that:mW personal possessions
have either been rernaved or may be destroyed arx!agm to protect,deed and save
harness Pine View COY and Crematorium from any and all dalms and demands
for loss of carw3ges why may be made agabut th$rn by reason of or connected with
the cremation of said remam andfor d'spcsition of said ream as d ..ed,bibedw
such claims are,or are not wholly Mess,false or fraUdLd"j*L Thy authorization in
addition to a regutar to rkd permit must any the remains.
3. All remains must be in a cukwit or suitelAte akerriate contaiw. Caskets and co rg
must be of a corntntsGUe alai.htsa styrafewn or pkmdc oonsakws ww be accepteci.
b00817,battery pads,i��r cell, radioactive
kW"'-or dw=M=to HmmVed Ve body bek a any remains wo be
wed.
5. Crernadons will be cornpleted w vying days(72 hours)of receipt of the
BurW Trans*Pem*and iml I vwCmmm Form.The awrlated remains will
be mailed via Rego U.S.1 witttri than s�
hard! the s c#i � ___ � 00
edr ILdCL'v`a$ :{ z�f �, '.ca.. d'sF+ E;: aI` e�_c.Rs i. ge
for this service.U. Cremation,Admintstration Costs and Reconftg ems:
Adult $330.00
C IC11 . (age 13 months to 12 yem) $180.00
Infants (SbMx am to 12 n ) $130.00
Overtime Cremations(Weddays) .09
Saturday Cremations SM.00