Loading...
Nolan, Kenneth R OF PINE QUEE9\�51BUr �.J E VIEW CEMETERY AND CREMATORIUM WAXER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745.4476 (518) 745-4.477 Funeral Director Fame ,�� ll t �M�tEL lV vla. C a s e# 3 Date Of Cremation T :me Cremation Started I� IoP Tame Cremation Completed Type of Container Remarks ' z> oP <ovL 3 pup +€ i � , Town of Queensbury Pine View Cemetery and Crematorium 21 Quaker Road,Queensbury,New York, 12804 Cemetery Office:(518)7454476,Crematorium:(518)745-4477 Authorization to Cremate The undersigned requests and authorizes Pine View Cremoorkun.in accordance wkh and subject to Its Rules and Regulations to the remains ct: )ux 2'rk- ©/N iU f� p lie (Name) (Sex) 3 IS OS Rrj Ills►-Yj WLIJspy✓ Y_ I.28-T,5' (street) (city) ( tdo) (231)code) who died on 1 0- y—�i day of 34 J 9 U� 20� at l f, A i,,,7r -rev,.,)u,� N Y r C f ri A l eNi 7'omii1 �e5_Ai�A� plow) ). Name and address of nearest living relative or name d pereon authorizing crernatiorc A N qe/p No/AA9 3 �� c1 s Rt4- Not- jrc.�d6o�✓ Juj/ )� ss (Nhme) (Address) Relationship to the deceased Name of Funeral Home �d W A &7y1�1 IMPORTANT. 1 op mom ttret to the best d my knowledlge,the deceased(has)or aker,delblaW.battery,battery peck.power cell,radloedive Implant or radioactive device in his or her body.(Ckde One) I ON*that 1 have ftm power and audxwb rim to arrange for the cremation of the remains and to diredx the disposition of the cremated remalro.that any personal possessions have either been removed or may be destroyed.and agree to protect,defend and were harmless Pine View Crematorium from arty and all claims and demands for knee or damages which may be made against them by d or Corrected wkh the cremation d said remains as directed,whether such claim or demands are or are not wholly 7-1f�'na 4>P � Gvr� r (Signs me and Address of Relative or legal Representative) Signed an this deter Disposhion of Cremated Remains I hereby direct Pkne Vlew Crematorkim to dispose d the cremated remains as follows: Mail to W1,1t(.c,� t)Q Other arrangements-Plesee specify: If puMrization of cremated ramains is requested.check here.2L-=-, N Revision:Apt A 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:OOam to 3:30pm. Prior telephone anangements for the acceptence.of remains 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 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. A I remains must be In a casket or suitable alternate container.Caskets and containers must be of a combustible material.No styro oam or plastic containers will be accepted. 4. Any cardiac pacemakers,defibrillators,battery,battery pack, power cell, radioactive Implant or radioactive device must be removed from the body 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$30.00 charge for this service. . 6. Cremation,Administration Costs and Recording Fees: Adult $330.00 Children (age 13 months to 12 years) $180.00 Infants (stilibom to 12 months) .-` $130.00 Overtime Cremations(Weekdays) $480.00 Saturday Cremations $480.00 M 1