Decker, Mildred TOWN OF QUEENSBURY
Pine View Cemetery and Crematorium
11 Qunker Road, Queenshury, NY. 72804.5902
(518) 74 5.44 76 (S18) 745.4477
http://w%vw•queensbury.net
Funeral Director:
e�(tint:''er
Name of Deceased:
Case Number: Z
Date of Cremation: N
t� (� Oo
Retort: 7
ISj C,gs_
Time Cremation Started: o 0
Time Cremation Completed:
Type of Container: �y91�i
Remarks:
M TO
" H0 it of Natural BeaitttJ A Place to Liue "
I
4 Z2
Dwn of Oueensbury
'ate Vow Cem 1mv and Crema>9 xkffn
21 Quaker Road,Ckuwabury.New York 12804
emelery Qiffoe:(518)745-4476,Crenetlodum:(518)745-4477
AudxxizoWn to Cremate
The undersigned Mqugo fend 9uMoUoS Pkte View Cmnooft .In, om audence w th ttrtd sut>jed to its Rules and Regulations to
te crema the rent p l o:oF. `'-
Mildred Decker Female
(► ) (sex)
76 Library Avent�g Warrensburg Ny 1.2885
O (Cky) (sty) Rip Code)
whodiedon 11th dayof May 20 08
at Westmount Health Facility
Name and address of netr"R tp retadve or name of Pars"auUtorizkg anemation:
Patricia Quinn 33 MacArthur Dr. , Glens Falls , NY
(Name) (Address)
Rekgkxv ittptothedeoaased .. Daughter
Name of Fun"Fiome Alexander-Baker Funeral Home
IMPORTANT:
I represent that to the baKAO ml►, ►tfte dec�eesed Qoo or fm no pmemaker:dWWlakw,battery,battery per+poww
cell,rafoecum iripi*oris oec a device In his or her body.(Circle tire)
I oerfify that I have fup[lower and at oofo tlort to arrange for ltee awadon of tfto romks and w cUed the dsposkm of the
crwnmd nxfw*w. I W .I- &hake o to been ra imad or may be deeftyed,and agree to protect,defend and
save hertMeas tsin m any and all claims and demands for Im or damages which may be made against them
by room n of said rerrwho as dbecW wttepter such claims or demands are or are not wholly
(wtatess) (Address)
(Sfgoetu m and Address of Relative or Nagai Rep ow totive)
Signed an this dale: May 12 , 2008
uisposMaon of Cmnv tad Remains
I hereby&W Pine View Crematorium to dispose of the cremated remabrs as fouows:
Mali to
ouWamvVerniarm-ploosespow. Funeral home will pick up
if pulverization of cminsood rernakw is mqueamd,chuck there X
Revision:Apr»18,Z007
>E \
Policies, Rules and Regulations
1. Pine View Crematorium is located on the grounds of Pine View Cemetery. The
cxeffmUxium operat s Mormby twough Friday from 7:O0=to 3:30pm. Prior telephone
all for the acceptance of remains are necessary.Prearrangements are
necessary for overfi me or Saturday cremations.
2. A 'Auth(Wh ation 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 direct the dlspositieon of the cremated remake,that any personal possessions
have either been rem NW or may be daWayad and 0"to pry dafend and save
for
Pine View Cer<netery and Cremaialmn fbm any and aft claims and demands
the remake may
made aWkwi
them won of or connected with
d�oWdon of scud remake as directed,whether
such claims are,or are not wholly glandless,Use arfraudulent.This authorization in
addition to a regular burial permit must acoompnny the remains.
3. All remains must be in a casket or suifebie alternate container. Casks and containers
must be of a combtsb{e material.No s4vokan or pfastle coati wn wi8 be aeoepted.
4. Any carrd'iac peprxttrars,defer battery,battery pack,per cell, radioactive
impiantor Rrdio®c"derbe must be removed hom the body before any remains will be
accepted-
5. w Ithresworkhg days(72 ho us)of reoM t of the
fur 'Tter R.Pprr0*4W & WkM* r fo:Ctdrtt�e Fotr L The cremated remains will
be[nailed via Register+ad U.S. K"i"thrM days of er+ernOm to the fiNwW home
hertd*V the service unless other amarr8emerds are made.There will be a$30.00 charge
for this service.
6. Cremation,Adn**Ma*m Costs end�Fees:
Adult
Children (age 13 months to 12 years) $180.00
infants (011born to 12 ffmft) $130.00
Overtime Cremations(Weekdays) $480.00
Saturday Cremations $480.00