Huus, William TOWN OF Q UEENS B UR Y
Pine Vieth Cemetery and Cretnntorinnn
21 Qtrnker Road, Queenshnry, NY. 72804.5902
(518) 745.4476 (518) 745.4477
h(cp://w%v%v.queensbury.net
Funeral Director:
Name of Deceased: iv I,ti.� 5
Case Number: L IU
Date of Cremation: Z 60g
Retort i���;�•��,c S'
Time Cremation Started: I IU
Time Cremation Completed:
Type of Container:
Remarks:
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21 Quakw Road.Oneffobwy,MM YOK 12804
'ecaeiery Olive:(518)745.4476.CMMOW*nr.(518)745-4477
AutNodZalioa to cramso
The w4wsWed rt1 t19Esbi+�ftt# 1AeMr c e1 4uIR 1n arFQ94�oe+M Wd bits RWes and Regutaaons to
cremate the reanidn��-:°,, ,
William A. Hu us Male
(Nam)
11 Garrison' `Lane L La.ke...,George, .NY 1•.2,845
O .-,.-.,-.�.- -. ( ►) 7(Sq�te) (Zip Code)
whodiedon 3rd day of r1aY 20 08
at Glens Falls Hospital
(Place) (Adftw) s
Name and address of nearest Oft relatlua or name of person autlwri*4 csamation:
u4� 3t , E! G�rvaZ�ram , Cfr &t�
(Name) (Andreas)
Reiatlor>s!V to tho deces"d'A,.
Name of Funeral laorrte' .
" i l'ekatider-Baker Funeral Home
IMPORTANT:
cell rat8oadivato d"paook or I{��i1 bod�l.(Cktde()rrttj�•dae+btMator.batlerY.t>eaery Pack.P�
certlly that I hava U power and awhori:at M to anartps for lei I'll of ltte ttanok wdlodkWdeftwskionof the
Crerrrated remak k tt aura 11 11 VV gr w lfe dwWgted.and aq=to per.defend and
save hsl N yf p arty artd a0 qqd r.."or, wNch awry be made a them
by reason of C of said as rw lher etch r, l or denranda are or arse not wholly
c
(Sianafure �4d.—ss of R6Mdm or Legal
Skpvd on this datw May 3, 2008
urspc s w of Cremated Res
I hereby direct Pk*Maw Cremae AM to dispoae of the cremated mmabrs as follows:
Mail to
otr,er aaangemerns_Please spur: Funeral Home will pick up
If Pia1vemBtion of cremewd n oneins is reque0ed,check two X
Revision:AprH 18,2007
Policies, Rules and Red lotions
1. Pine View Crematorium is located on.ths.gratnift of Pine View Cemetery. The
cxe<nafoti irrt operetea Mprday a. _*FO ft fm n?:OOlara to 3:30ptn. Prior telephone
arrangerneirie ta'tlte acceptance otrerheins ere necessary.Prearrangements are
necessary for overtime or Saturday cremations,
2. A 'Auftristion to Cremate'form signed by the nearest need of kin is necessary stating
that OY do have the power and auOKAty to arrange forft cremation of the remains
and to direct the dbposidw of the cratreted remems,that any personal possessions
have either been r+emOved or may be desNoW arrd agree to protmi,defe W and save
hamfor 4 of�View Ce1 ► claims*om any and aN mid demands
which may be made egoirt6t them by reason of or corumkied with
the cremation of said renr1mins w4tr d oposgion of said reruns as directed,whether
such claims are,or are rrot wholly gminclaW Use or*aUdukx*This authorization in
addition to a regular burWA permit must accompany the remek1s.
3. An remains must be in a casket or suit"akernme contWner. Ca* is and eoraWners
must be of a combustible material.No stynalmn or plevtic cxxfeinerswis be accepted.
4. Any ce"Mc paoetttakers,deribrilieeors,banery.bwery per.power cell, radioactive
implWoor°sadioec Ove device amst be ramowld n tie bWy before any remains win be
acceptecL
5. Cremaiaiprr$wlii be wshin hire VJOd ft days(72 hours)of receipt of the
Bt xlai=,Pem*-WW Autotf tiort Iirrt.TEte ca remaid ns winbe ma
e sltwe l U.S. iili t#Allirt l' ft dawof ounoom io the funeral home
handling the service urdm other WMQM are nrede.There wN be a$30.00 duwW
for this service.
6. Cremation,Administration Costs and pAWFft Fem.
Adult
C.hiidren (age 13 monttrs to 12 years) $180.00
ln%M (stilton to 12 months) $130.00
,
Saturday Cremations $moo