Schuster, Gerard OF QUEE9\�StBury
PINE VIE: CEMETERY AND CRE 1
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QUAY-ER ROAD, Ql1EENSBURy, MATORIUYORK 12804
(518) 745.4476 ' NEW
(518) 745'•4-477
R Funeral Director
Name G, �W
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Gate Of Cremation
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Time Cremation °
Started '7. 3v
T , me Cremation Com
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Type of Container J �' 1 Rem Ks ar G�� bDq( C. ", o,�! 5
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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-"77
Authorization to Cremate
The undersigned requests and authorises Pine\r*m Cremakiium,in aa=danoe vka and sut pa to its Rules and Regulations to
cremate the remains of:
Gerard A. Schuster male
(Name) (S841
Six Library Ave, warrensburg, NY 12885
(sue) (CRY) (state) (ZIp Code)
who died on 18 t h day of Sep 2008
et Glens Falls Hos .
(Place) (Address)
Name and address of nearest iiv ft re1liffive or name of person auV=I&g c rematim
Elizabeth Schuster Same as above
(Name) (Address)
Relationship to the deceased Spouse
Name ofFunerel Home Alexander-baker FH, Warrensburg , NY
IMPORTANT:
i represent that to the hest of my knowledge,the deceased 0"K(Ims no)pacernakw,deMxMaW or any other battery operated
device in his or her body. (circle One)
I certify that I have full wtltor¢atim to arrange for the crerm*in of the remains and to direct the disposition of the
awrow re�iresf>-at any p heve eater best removed or may be destroyed,and agree to protect,defend and
save mess Pine view orium from any and a8 and desr�for toss or damages which may be made against them
of with the aerrisZlaort saw mars as erected,vrTte0rer such klairms ce derrtatds are or are riot wf lolly
g .
Warrensburg, NY
(war>ess) ( )
X me as above
of or Legal Representative)
I
signed on trus Gate: 9-18-0 8
I
Disposition of Cremated Remains
I hereby direct Pine view Crematorium to dispose of the cremated remains as foUaws: j
mail to
I
Other arrangements-Please specify: F H will pick t i p
If pulverization of cremated remains is redtuested,check here X
Revision:4Wy--k,3004
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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 ne)d 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 vvorking 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 charge
for this service. 3A,�1
6. Cremation, Administration Costs and Recording Fees:-
Adult 33:J.
Children (age 13 months to 12 years) SISO- V 90- `
Infants (stillbom to 12 months) AD9-.8Q" /.3c- j3