Nash, Betty r-r
l O O
QUEE9\"50Urp
P LNE
VIEW CEMETERY AND CR
WAXER ROAD, EMATORIUM
QUEENSBURY, NEW YORK 12804
(518) 745.4476 (518) 745*-4477
Name
Funeral Director
Case#
_Date Of Cremation v�
Time
Cremation Started
Tame Cremation Completed (�
Type of Container
Remarks -01
AL.
Cov 30
M
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t7 m o(Queensb1/Y
Am View COMONY pad Crain rk
21 tittdw R06A Qugeuabti>sy.New YOM.12804
'e=%Fy OM=(518)745.4476.Cmmla1oe urw.(518)7454477
Audwtbulatt o Crl woe
The AWWSVW a1d a Ittot eq.Pirte'Vtaw *ft Wd to its Ruin and Ragutettons to
CrerrlHtethe lelnd�(�^a'��'..' .
Betty Nash Female
(tee) tom) ,.
15 Stady'8't'. WarrenS.lj�xg, 'NY 12885
(SUM) (Cab) (State) (p Cam)
„hodWa, 12th �y� April jn08
at The Glens Falls Hospital
( ) (Ad )
Name and address of Peen ud 9ft nal Wn or nmw of person stattod tg cremation:
James Nash R-ivr . Warrensburg
( ) � ' (AddreW)
ReWonaMp to the deoeesed s o n
Name ofFunerslNoms 'Alexander-Baker Funeral Home
IMPORTANP
I represent that to t" eet.Of*v IvtDxbft%ft deoese6d Qv*a Qles no peoentaloer,de0brlilmor,bMwy,basmy paCk,pow
ce I,radioactive irnptar><or radiosdh a device in his or her body.(circle One)
I certify that I hams U power and SIAlgr WOM to WOW for the Oentefion of fhe ratrtatrts and b dW the dk;pos1tW of the
�ee�t ttaMe a gr_baert t1MtloMaf!fX;atrey i mod,and free to POW,deferW and cMe OM t OntelorftlAd end all Oqd lar o a.�wMd►grey be nude agaktst them
by reason of rriii(:ye�l "tlhe" cf avid remains as t�edeif;{ ier ends clRYne or demands ar e a are not wholly
fuser
lvMitrtess) (Aftem)
.� ly and Address of Relative or Legal Represerfttm)Sonsue
signed on this date: April 12 , 2008
uisposition of Cremated Remains
I hereby direct Pk*View Cmnmkwkxn to dispose of the cremated remains as foilows:
Mall to
other arrarvernem-Pwmepo Funeral Home will pick up
It puiverbation of cremated remebw to.requested,dreck here X
I
RevWw:Aprf118,20O7
Policies, Rules and Reguistions
1. Pine View Crematorium is located on the grounds of Pine View Cemetery. The
cxemat dUM operates Mostd'ay through Fr day from 7:00orn to 3:30pm. Price telephone
arrangemer>tt 1br'the aooeptsnoe of remains are necessary. Prearrangements are
necessary for overtirne or Saturday cremations.
2. A 'Authorization to Cremate'form signed by the nearest next of kin is necessary stating
that they do have the power and authority to arrange for the cremation of the remains
and to dined the disposition of the awed rterr>ns,that any personal possessions
have either been removed or may be destroyed and agree to protect,defend and save
hamfor * of f View Carr am fro
y and Cm any and ad claims and demands
d which may be made SgWM them li f reason of or oonrt xIed with
- the cremation of said remairN and/or disposition of said remains as directed,whether
such claans are,or are not wholly groundIM fate or fraudulent.This augWrization in
addition to a regular burial permit must accompany the remains.
3. All remains must be in a casket or suitable alternate container. Caskets and containers
must be of a con ma3teriaL No"Okwn Or PMW Ooraairlers wiN be accepted.
4. Any cetdiac pamnakers,debbrittalos,may.battery Pik Power cell, radioactive
urrplant or redioeretiye.device must be removed from Ow body before any remains will be
5. Cnematiors vA be eon>pleted vtrithin ulnae work ft (72 hours)of receipt of the
Burial Trar>stM Perms and ALOWFIZetion to OWNS Form:The cremated remains will
be mailed via Registwed U.S. Mal wift ttmee days of c:nemom ioV a*atonal home
handling the service unless other errangernerss are made.There wilts be a$30.00 urge
for this service.
6. Crernatiorn,Administration Costs and PAMUd ng'Fees:
Adult
Children (age 13 months to 12 years) $180,00
Maras (stiNborn to 12 months) $130.00
Overtime Crernadons(Weekdays) $480.00
Saturday Cremations $480.00