Morehouse, Raymond I
t';,tOVirt,WN OF QUEENS13URY
21 t Cemetery and Crru1410riUNi
518) 745.4476 Quaker Rond
(5 , Qtrtrltshury, NY. 12804.5902
htfP://www.queensbury.net (518)74 5.44 77
Funeral Director:
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Name of Deceased:
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Case Number. 7-
Date of Cremation:
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Retort: ' . ��
Time Cremation Started:
Time Cremation Completed:
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TYPe of Container. 4 / 4
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Remarks:
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" Ho „ e Of Natural Beauty ... A C0011 Place to ,► ; " ",
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Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road, Queensbury, New York, 12804
Cemetery Office: (518) 745-4476, Crematorium: (518) 745-4477
Authorization to Cremate
The undersigned requests and authorizes Pine View Crematorium,In accordance with and subiect to Its Rules and RegutatKoru to
:�;.
e remains of:
��� /"1ore�o,�S
me) (Sex) �—
171 1.4�,-f+,.
(street) (City)
(state) (zip Code)
who died on day of J,.,�. 20 66
at 1 / `t. Jjev� N I I a Ba,Z
(Place) (,address)
Name and address/of nearest living relative or name of person authorizing cremation: //
nJ�fy G.G ��I 3L .b, r�'1�: vy (oLaytr>yik
(Name) (Address)
Relationship to the deceased t
o
Name of Funeral Home ,,,,,� -�
IMPORTANT:
I represent that to the hest of my ivtowledge,the deceased(has) no)pacerrtaiCer tator or device In his or her body. (Circle One) any other battery operated
I owtfy that I have full power and authorization to arrange for the cremation Af the remains and to direct the disposition of the
cremated remains,that any personal possesskxu have either been removed or may be destroyed,and agree to protect,oetend and
save harmless Pine View Crematorium from any and all Claims and demands for loss or dams which�y be made against them
by reason of•or connected with the cremation of said mnalns as directed,whether such claims or demands are a are not whotiy
r lent (a n (
( )
(Slgnalure and Address of Relative legal Representative)
Signed on this date: -� "tee- , t �C 0 p
Disposition of Cremated Remains
1 hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mall to
Other arrangements-Please specify:
If pulverization of cremated remains is requested,check here
Revision:January 1,2006
OF QUEE 0
PLNE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY NEW YORK 128C4
(518) 745-4476 (518) 745-4-477
Funeral Director A�extiAdc+�
Name oN- .
Case# 31L
Date Of Cremation 'r
Time Cremation Started '0S _
Time Cremation Completed 3;2�
Type of Container
Remarks
Uv � 2.od M
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Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury,New York, 12804
Cemetery Office:518-745-4476,Crematorium:518-745-4477
Authoriza*m to Cremate
The undersigned requests and authorizes Pine View Crematorium,in socordarm with and subject to Its Rules and Regulations to
cremate the remains oF.
Raymond 0. Morehouse Male
(Name) (Sex)
2500 St . Rte 8 , Bakers Mills , NY 12811
(meet) (CRY) (state) ( lp Cam)
who died on 9 t h day of J u l y 20 08
at Westmount Health Facility, Queensbury
(Place) (Address)
Name and address of nearest 4ving relative or name of person authorizing cremation:
Kaye Heath PO Box 348 , Chestertown, NY 12817
(Nam) (Address)
Relationship to the deceased Daughter
Name of Funeral Home Alexander-Baker Funeral Home
IMPORTANT:
I represent that to the hest of my knowledge,the deceased(has)or(has no)pacemaker,defblator or any other battery operated
device in his or her body. (Circle One)
I certify that I have full power and authorization to errarge for the c enra m of the remains and to died fhe disposition of the
cremated remainm that arty Dersandtasses
sions have either been removed or may be destroyed,and agree to protect,defend and
save harmless Pine�liewt rfim any and al claims and demands for loss or damages which may be made against them
by reason of nected with the mation of said renal=as directed.whether such claims or demands are or are not wholly
ground Ise or traudu
- Si3.J✓1.C>
( )
/ r
( Address of Relative or Legal Representative)
Signed on tnw date: July 9 , 2008
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as tdlows:
Mail to
Other arrangements-Please specitr i yy u-n`Cl Lip.
If pulverization of cremated remains is requested,check here X_
Revision:44,
l8(j11",07
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 acceptance of remains are necessary. Prearrangements are
necessary for Saturday cremations.
2. A "Authorization for Cremation"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 disposition of the cremated remains, that any personal possessions
have either been removed or may be destroyed and agree to protect, defend and save
harmless Pine View Cemetery and Crematorium from any and all claims and demands
for loss of damages which may be made against 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 are not wholly groundless,false or fraudulent.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 combustible material. No styrofoam or plastic containers will be accepted.
4. Cardiac pacemakers, defibrillators or other battery operated devices must be removed
before any remains will be accepted.
5. Cremations will be completed within three working days (72 hours)of receipt of the
Burial Transmit Permit and Authorization to Cremate Form. The cremated remains will
be mailed via Registered U. S. Mail within three days of cremation to the funeral home
handling the service unless other arrangements are made. There will be a$26r00 charge
for this service. , L�
6. Cremation, Administration Costs and Recording Fees:
Adult $300:ff- 310
Children (age 13 months to 12 years) S16G.W 190- `
Infants (stillborn to 12 months) VDG-N- 43D,`'�