Preston, Helen OF QUEE%-593Ur
LNE SEW CEMETERY AND CREMATORIUM
QUAKER ROAD, Qt1EENSBURY NEW YORK 12804
(518) 745-4476 (518) 745.-4477
Funeral Director
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Date Of Cremation �— 30 — �$
Time Cremation Started ;pd
T :me Cremation Completed 3:00 h
Type of Container ( A
Remarks S�
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own of Oueensbury
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21 tluaker RD8d,QUeendWy,New Yak 12804
-w ellery Ofte:(518)745.4475,'Cremel rkff :(518)745-4477
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The undetB rtigtfoeta tWtotl ea ftle'V ew C,Y1, pD1d9pDB V* 1 d subject to its Rules end Regulations to
cremate the remebis ak ``. e , . .._
Helen Preston Female
(Flame) (Sex)
Adiroridaok Tri-County NH North Creek, NY
O tc�ty) ts>aate) pp code)
whodiedon 27th dwo1 January 20 08
at Adirondack Tri,-County Nursing and Rehab Center
(Place) (Address)
Name and addressyof nearest Gulag relalve or name of person oLdx rk*V rxearabw
Thomas Preston PO Box 8 Piseco, NY 12139
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Relatlonshfp to the deceased s o n
NameofFuneralNome Alexander-Baker Funeral Home
IMPORTANT: j
I represera that to ths.beat Qf,my bto wlsdps.the deoeeaed(tree) ro) maloer.deflbrlM m,bettery,�y pe&,.Wwer
cell,rafoec"irrupt t or fledittetltiViB dbvim in his"her body.(
I oartlfy that i have iiA portw end authorization to atrwW for Ste txem dm of the rantaft and to direct the disposition of the
cxentated remains,lhOtR- 4.w
="inta
POd44a91Or1S heov96x b0(N1 pM1tOnBd Qr dtW 0..0 dGWO"d,end aWw to prOISM deferw andsave harmless Puts Viet from arty and ap bss or dGteapes Much atry be made them
by reason of oraowt6btntedon gEsdd rameinsaft ier suds claims or.1-M—N de are or are riot who#y
grourdiess,false ,,
ClIAOL
(Slgnatlrre and Address of ReMive or Legal Rep ssw tettve)
signed on this date: January 28, 2008
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uisposillWl of Cr auftd Remains
I hereby diced Pine View Cnenmftdum to dispose of the cremated remakm as follows:
Mail to
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other arrmgemenrs-PteasespeW. Funeral home will pick-up cremains .
If pulverizstbn of aemeoad wnakw is mquesoed,dv*here X
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Revision:April 18,2007
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Policies, Rules and Rations
1. Pine View Crematorium is located on the grounds of Pine View Cemetery.The
orator um c amas WF4aY .Ft W i om 7:00W to 3:30pm. Prior telephone
arrangem6htiforthe eooephnoe of r+errteiree art necassary.Prearrangements are
nary for overdme or Saturday crenudwis.
2. A 'Authorizatioru to tom'form signed by the nearest need of kin is necessary stating
that they do have the power and Hutt ft,10 mange for the cremation of the remains
and to direct the disposition of the cremated remains,that any personal possessions
have either been remoind or may be domed and 89M to protect,defend and save
harmless Pk*View Cemetery and Crerna xMn from any and all clekns and demands
for loss of damages which may bei medet again1tNem*iiison of or connected with
the cremation of said remains andfo r ft-a ftio ;of said term**as directed,wtether
such claims are,or are not wholy qMw wee ar*audttiert.This audxxization in
addition to a regular burial permit must accompany the rena ns.
3. All remains must be in a casket or suitable akemate corms. Caskets and containers
must be of a combtrstibte mated.No dyiabn or plra qtie aottaaners wiv be aooepted.
4. Any cardiac V a nakers,defib
battery,betttety peck,power Dell, radioactive
imp last or radlosOft.device must be a IMMMI,untib t before any remains will be
accepted-
5. Cret.._4,'ems wilt be amVk bed wrduin ti imer mdit days(72 hours)of receipt of the
be rial Trar .Permit and Auttto t00p*�- Foram.The cremated remains will
be mailed v�Registered U.S.Matiwidlirl thtft dteys Of txWrtation to the ftinwal hone
handihug the service umless other ariarge are made.There wS be a$30.00 charge
for this service.
6. Cremation,Administration Costs mW pACOFft Fees:
Adult
Children (age 13 months to 12 years) $180.00
Infants (sWtKxn to 12 months) $130.00
Overtime Cm t dofw(Weekdays) $480.00
Shy Cremations $480.00