Wert, William Sr. a•
L O O
PINE YI E QuErEg\�5�Bur);L
w CEMETERY q
QV�R ROAD � CREMATORIUM
QUEP.NSBVRY. NEW PORK 12804
(518) 745•4476 (S18) 74S'-4-477
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Funeral Director
Name r Art �-
£ Cased [� 0 e Of Ccemati,on
Time
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Completed
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Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury.Never York, 12804
Cemetery office:518-745-4476,Crematosiurm 518-745-4477
Authorization to Cremate
The urxWsigned requests artd auawtme Pk,,Vj w Cawatamuu.in acmedmwe w&h and sect to its Rules and Reputations to
cremate the remains at:
William G. Wert SR . Male
(Name) (SIS4
11 Fourth Avenue, Warrensbueg, NY 12885
Code)
(-Street) (City) October paw)
� 08
who died on $t h day of
at 259 Kelm Pond Rd- , Warrensburg, NY 12885
(Place) ice)
Name and address of nearest tiv ft rune or name or person awwriang ate:
WM W(5&7 Z R 31 t 0 _r. LIB gj2,!X„�
(Name) /
Retationship to the deceased
Name of Funeral Horne Alexander-Baker Funeral Home
IMPORTANT: the deceased(�)or�no)��or am other banery operated
i represent that to the best of my krtowied$e,
device in ttis or her body. (Curie One)
I ceitifp that I have tuff power and WAwdzaWn to strange Ibir>he mot►of the riemains and to direct the disposition of the
cremated remains,th er f�p �e�been rewaved or may be dest[oy�.and agree to protect,defend and
save harm Viewy
B 0er�t afi wall ngr�+s dmc3ed, such or deme�
or te' e View �not*ftItyy
by
g false or
(Address)
(Signature and of
5ignea on trns date: October 9 2
Disposition of cremated Remains
I hereby direct Pine view crematorium to dispose of the cremated remains as fotbws:
mail to
Other arrangements-Piasse specilY:
FH will pick up
If pulverization of Cremated remains is requested,checK here X
Revision:J7 38174
jS rat'='=07
Policies, Rules and Regulations
1. Pine View Crematorium is located on the grour►ds 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"s.Wied by the nearest ne)d ot kin is necessary stating
that they do have the pow and au#=ity to anange for the cremation of the remains
and to direct the disposition of the cremated remains,that any personal pions
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 dispo�on of said remains as directed,whether
such claims are, or are not wholly group,use or ftaudLdent.This authorization in
addition to a regular burial permit must any the rernaths
3. All remains must be in a casket or suitable alternate Container. Caskets and containers
must be of a combustible material. No styrolbarn or plastic containers will be accepted.
4. Cardiac pacemaker$,deftnUattus or odw try operated devices must be removed
before any remains MH be acceptExL
5. Cremations will be comp&eked wMm ftee wwVxig days(72 tours)of receipt of the
Burial Transmit Permit and Authtxization to Cremate Form.The cremated remains will
be mailed via Registered U.S. NW yid thrive days of cremation to the funeral home
handling the service unless other arrangements are made_There will be a0 charge
for this service.
6. Cremation, Administration Costs and Ring Fees_
Adult 3 i s. 0-
Children (age 13 months to 12 year) $350-- - 190-
Infants (stillborn to 12 months) 000-W-