Goodman, Philip �O O
QUEEN.5BUr
PINE VIEW CEMETERY AND CREMATORIUM �-y
QUAKER ROAD,
QUEENSBURY. NEW YORK 12804
(5 18) 745-4476 (518) 745-4477
\'ame
Funeral Director „eR
� "
2j
Date Of Cremation Case#
Time Cremation Started
Time Cremation Completed 121-0
Type of Container
Remarks C 'Q
d :0a
00A
1 -36
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Totem of Queambititry
!Pine View Cemetuy and Crernatorfm
21 Quaker Road,Queensbury,New Yodr, 12SO4
Cemetery O#Ce:(518)745-4476.Ommaweium:(518)745-4477
Auftu zailan to€fie
The wideisWW MQWW atd SAWOOS RM View 01OWWW.M end to ft Rides and Ito
crenate the r ct
Philip D. Goodman Male
( ) (SeK)
. .LA( <2y Z
( ) (c~'- (sue) a (Zip Code)
,,,*m&wDn 2 9 t h ,wot December 20L 07
W Tri-County Nursing and Rehabilitation Center
Name anxl address of nearest*AA n**ve or name of persan aLdxAwV cremation:
Philip Goodman 664 Goodman Rd. Johnsburg, NY
(N—W) O .
Heiamonsrap to the dada S o n
NarreotFuneralmme Alexander Funeral Home, North River NY
IMPORTANT:
I represent t u d to the best of aq ietOwkK%,8,the deceased etas)or(has no)pacemaker defibrillator may.bMW pa&,pow
cell,radioactive knplw t or radoscHve device in hfs or her body.(tide Ow)
I cenfly that I halve fug power and etdw f wWn tD eaaMs for the QE;4f e*m of v e moz!ns eW to a�w itta 6Bposwon of the
crernmeMrsmakla.8184 pexeorwi posses tl 9 bit n=17mmad cr fnW be deco&ed.aid t>C to prniect.defend and
is XdamqpsvdridsMwbetoede egul stilmn
IEY such cmiomor deist 1 are or are not wholly
413
(SOvMA and Address ofPcelefia or Legal Rep vW)
Signed on this date: t —/ `•
Ubposibon of Careawd d Reffairm
hereby drew Pine View Cremakwitim iQ dLSpo of the cn wa ted rem as ioi m$;
Mam to
QOW arrangmem_PMWS . Funeral Home will pick up
If puivervatfon of memMed nw mr s is re*000d,check inane
Rw4kW t::VM 13,2W7
Polices, Rules and Regulations
1. Pine View Crematorium is located on the groom of Pine View Cemetery.The
csei natorkmn operates Morey through Friday from 7VOem to 3:30pm. Prior telephone
arrangements for the acceptance of remains are necessary.arrangements are
necessary for overtime or Saturday cremations.
2. A *Auffmrbmfion to Cremate'foam signed by the rarest nwd of kin is necessary stating
that they do have the power and authoft to arse for the crerrisfion of the remains
and to direct the disposition of the cam- .ed r. :n .Di have either been removed or may be da oyeo _ y ,daYwnd a o.:e
fbr hOss Of d8mefc—O s Which he ,j n of or corrected with
such claims are,or are r-o±wh04f. C'n~V-Kq"- w,fw'sa- 'a *Th-TswitWizationtm
J JL�_._ •_ r_ s_r _
CAAi'b'U�JpIdY�J1 U 633 L2 33����.j}L2�:'3�Xpi ,'°.}-i�1:C��tig����.C�d}d:,�:gd 5¢'.t.'•s.".}ry.}'.s.,�i..3r+gv- i.±��'i�+{ate_ � -_ .`-•_ -
I /'mil remains must be in a casket or��.�Jo Lays'R2t<
must be of a vombustlle nit.No styes cT p%,sale awteirtws val be acaepwd-
= pack.pmr tail, radirective
d r t the body Wore remains wilt be
..�._-��� -°�,'-�.�. �. w.
accepted.
tf '-*mA V do"Q2 hows)of receipt of the
n ; N �"n t and "�'v inn to Crenme Fom The cremawdremahis will
be�.,t��lled via R�U.,,, ..t! 17,Y and*V the un RL�C iz am. -v e'h6.��-Y:. fk 4:$
for Otis .Service.
B. Cremation.AdrnarftUWon Costs wd d'-.u.—
Adult $33tD.00
"Wen, (age 13 months to 12 years) $180 00
;: (sWffvrn to 12 ator ) $130.00
Ovwtlinm Crernatioris( eeKftS) $480.09
Saturday Cremations 84N.00