Tuma, Robert OF QUEE BUQ�y
PINE 'VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENsgURy NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director / lyri-►der
dame o ^r� ( vow
Case#. 5 ��
Date Of Cremati.on
11«
Time Cremation Started 7.o
Time Cremation Completed
Type of Container
Remarks ehs
`t 00
r1-3v j
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' I
Town of Queensbtay
PIM VISW ceereefOry drat!CrenUdDrkffn
21 Quaker Road,Queenw*ry,Nm York, 12s04
Genaelery Office:(518)745-4476,C4emauxkm(518)745.4477
AtlVtt to Car+emae
Ttte urtdatsigned ram and ay#Wtans PIM VIOW OMMG5MkM m 8CCUFdWMVft and to its Ruts and Regulatlom to
cremawthe at
Robert J. Tuma Male
(Name) (Seal
3136 State Rt . 28 , North Creek, NY 12853
(sk") (CRY) (State) (Zip Code)
who dial on 6 t h day of Dec 20 07
m Glens Falls Hospital
(PWW) ( I
Name and address of newest&Av reladve or name of person auVxffIzvV cremation:
Mary Tuma, Same as above
( ) (Address)
Rewords ip to the dweased Sp o u s e
Alexander FH, Inc, North River , NY
tti OMANVT:
t represart;that to the bast of my k e,ft deoe+wd")k pma no)pacerad wr,dell!)tdBBlIor.may, Y per,poWer
cell,racdoecdve knolot or radlowlim devios to his or her body-(Ch de One)
i oerW that I have U potrar and Mo on tomrraags iambs crmmftn d vm rt and jD dhect die disposkion of the
«enrataa rem, V posseedw s hum ester beet NOWANO W MW exs ,doll Sow to prinlect,deed and
save hwndW;-FWle View Cla m ftm whr and all ciftsarid for lam ar damages whkh a m be made mm mote"
by mpnff of or whh the awwdon ofsdd fWm*s es&ecd, such rd s or ftTmnds we or sr a not Wx*
�Wa6iffim% 4r*au*AenL
Warrensburg , NY
C. - (wibress� (Ad*ew)
X �' r Same as above
( and Aridness of Reiedve or Legal Reprewtolve)
signed on this date: 12-6-0 7
EKsposOM of cremated Rmneft
tweby d rec t Phis view CrernaWrkxrr to depose Of" d remains as tolls":
mad to
om,&,ffv rnems_please spud FH will pick up
If wh emsdon of aenmtad mmem is mWosted,dock here X_
RavWn:Apli11$.2U07
Policies, Rules and Regulations
1. Pine View Crematorium is Il x ad on the grounds of Pine View Cemetery.The
crematorium operates Monday thaough Fdday frorn 71.)Own to 3:30prn. Prior telephone
arrangemcx+ts for the aoce roe of rerridres are necessary.Fh eenangertrerft are
necessary for overtime or Satoday awrnafians.
2. A "Aud oftaron to CremaW farm signed by the nearest next of kin is necessary stating
that they do have the power and auk to ammW for the cremation of the rem6ins
and to direct the disposition of the cremated reneges,dot any personal possessia�
have either been rerno ned or may t3 desh%ead and agree to pirotect,defend and save
tumdess Pine View Cernetary and CreavahoFlurn*ern any and all clailms and demands
for loss of dams which rreay be rr Ike by meson of or connected ve th
the c remartim of seld rernWtvs disp oe t of cmldrernabrs esdirectedWwOw
such dims are,or are rent why groundleas,lobe or Est This a M o lization in
addition to a regular bLKW permit must accompany Vve remains.
3. All remains must be in a casket or stile allerneW cono4ner.Caskws and contahms
must be of a vanbustibie rrobsialL to sty or s wM be accepted.
4. Any cardiac paaernake s,del rille6-m,berry,leery pack,power cell, ra6Ka::ttve
Implant or radioeOve.devlae must be removed#rem the body before any remeins will be
accepted.
5. Crerneft ns will be coinpeted wry#vree wodwq daps(72 hotm)of receipt of the
Transrrril Perrmit and Ot t ID Cie Fern.The cremated rerr a s will
be mailed via Registered U.S.MaIv&I'M*mftsd crem den to the bmevel home
handling the otter �-:. seers .Tfine wO be a$30-W charge
for this service.
5. Grena",Ac3ministratlon COM and ReWrdkV Fees:
Adult $MO-W
CWldren (age 13 morel *to 12 yeas) $18.tO
lnfants (stillborn to 12 ) $130.00
Overtime Cremations(ftdWa") $480.W
Saturday Cremmtisons .tx3
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