Eldridge, Jerry TrO WN OF Q UEENSB UR Y
CemeteryPil
21 Qunker Rond, Qu �eensbu y, NY. 12804-5902
(518) 74 5.44 76
hrtp://www.queensbu (518) 745.4477
ry.nel
Funeral Director.-
Name of Deceased: d
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Case Number: Z
Date of Cremation:
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Retort: C;�w ���
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Time Cremation Started:
Time Cremation Completed: L)
Type of Container:
Remarks:
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lopm ofUmmsbury
3k a View Cemelery and Crematorium
A Quaker Road.Queetsburv,Nm York, 12804
_wry Office:(518)7454476,Crest Wdum:(518)745-4477
Authorization to Cremats
The undersigned requests and atcthortzes Pine View Oreemorkun.in accordence vmh and subject to its Rules and Regulations to
aerrow the rernakts of
Jerry J. Eldridge Male
( ) (sex)
233 River St. , warresburg, NY 12885
( ) (may) (state) (Zip Code)
v"died o, 17th day Of May 20 08
athis home (same as above)
(PAM) (ems)
Name and address of newest Crying relative or name of person a Mx rb*q cremation:
Eldridge, 12 prti-f-- ,'� Ua c.lYa2�wj��>� xj
(Narne) (Address)
Rewoonship to the deceased B r o t h e r
Name of FuneralHw* Alexander-baker FH, Warrensburg, NY
IMPORTANT:
I reprint that to the hest of my Ivtowledge,the deceased*AV&Om no)pacemaker,dell"ator,battery,beltery peck,power
cell,radioactive implant or radioactive device in his or her body_(Circle One)
I aanily that i have MR power arld Stwrizabon to arrange for the aernatiM of the MM8111S and to threat the cksposition of the
cremated refrain,that possessions have elther bean removed or may be destroyed,and agree to protect,defend and
save hwnftss P' Cre from any and ad claims and de rends for lom or dama8es which may be made against them
by reason the cremation of seid ememb as dhwl ed,v**dw such claims or demands are or one not vAx*
.false or
Warrensburg, NY
) {Address)
ame as above
(signature and Address of R or Legal Representative)
signed on this date: 5-18-0 8
utsposition of Cremated Remains
I hereby direct Pine View Crennstorlum to&Vose of the aemated remains as follows:
Mall to
otner affangeffmfm_Please speW. FH will pick up
if puivermation of cremated remains is reVeOmd,cheat hers X
Revision:Apdt 18,2007
Policies, Rules and Regulations
1. Pine View Crematorium is located on the grounds of Pine View Cemetery.The
crematorium operates Monday through Friday from 7:00am to 3:30pm. Prior telephone
arrangements for the aooeptwioe of resins are necessary.Prearrangements are
necessary for overtime 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 arringe for the cremation of the remains
and to direct the disposition of the cremated remains,that any personal possessions
have either been removed or may be destroyed and agree to pry defend and save
harmless Pine View Cemetery and Crernatorlunn from any and aN claims and demands
for loss of danwges -
which May be made egairmt them by reason of or connected with
the cremation of said remains and/or disposition of said remains as directed,whether
such claims are,or arse not wholly groundless,false or ttwkdent.This authorization 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 corm le nottsbi.No styrakomn or plastic corawlem win be accepted.
4. Any cardiac paoernakers,defiibriilators,battery.battery pads,power coil, radioactive
implant or radioactive device must be removed from the body before any remains will be
acvepted.
5. Cwemations will be completed wddn three workitV days(72 tours)of receipt of the
Bun al Transmit Permit and Auth mmdon to Crime Form.The aemated remains will
be mailed via Registered U.S. Mal wittwl three days of cremation 10 the its home
handling the service unless odwarrangernents are made There w0 be a$30.00 Charge
for this service.
G. Cremation,Administration Costs and Recording Fees:
Adult $330.00
Children (age 13 months to 12 years) $180.00
Wants (stilxom to 12 months) $130.00
Overtime Cremations(Weekdays) $480.00
Saturday cremations $480.00