Currier, Marlene OF QUEE9\�50urR_y
PLNE VIES' CEMETERY AND CREMATORIUM
QUAKER ROAD. QUEENSSURY NEW YORK 12844
(518) 745-4476 (518) 745-4477
Funeral Director TT,LtsoA)
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Dace Of Cremation
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Time Cremation Started
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Remarks
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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 subject to Its Rules and Regulation to
cremate the remains of:
Marlene M. Currier Female
(Name) (SM)
52 Grant Hill Court Clifton Park NY 12065
(Street) (City) (State) Rip Bode)
who died on 21 day at Oct. 20 08
at St. Peters Hospital, Albany New York
(Piece) (Address)
Name and address of nearest Wing relative or name of person me ortzing cremation:
Mark Currier 37 1 /2 Champlain Ave Whitehall NY 12887
(Nam) (Address)
Relationship to the deceased SON
Name of Funeral dome Jill son Funeral Home Inc.
IMPORTANT:
I represent that to the best of my I nowledge,the deceesed(has)or(has no)pacemaker,definrillator,betters,betted,pads,power
cell,radioactive Implant or radioactive device in his or her body.(Circle One)
I cerdfy that I have foil power and authorization to annnge for the cremation of the remalns 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 Crematorium from any and all dolma and demands for loss or damages which may be made against them
by reason of or connected with the cremation of said remains as directed,whether such claims or demands are or are riot wholly
x2 Sycamore Drive Queensbury NY 12804
(Address)
rAA-,--!�--- 1 /2 Champlain Ave Whitehall NY 12887
(Signature arKrAddress of Relative or Legal Representable)
Signed on this date: Oc :. .2 j
Dispoeitli of Cremated Remains
I hereby direct Pine View Cremetorlum to dispose of the cremated remains as follows:
Map to
Other arrangements-Please specify:
tf Pulverization of cremated remains is requested,check here
Revision:April 18,2007
i
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
arrangements for the acceptance 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. 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. 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 (stillborn to 12 months) $130.00
Overtime Cremations(Weekdays) $480.00
Saturday Cremations $480.00