Millington, Philip rrn
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PWE VIEW �QUEE-AfqOU r
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CEMETERY ANp
QUAKER ROAD, QVEFNSS CREMATORIUM
(S 18) 745.4-476 t1RY' NEW YORK 12804
(S18) 745•-4.477
Funeral Dire
Fame Cr
I Director
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Time Cremation
Started 700
T ; me Cremation
T lion Completed v �o
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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 undersgried requests and arthort m Pane lrreur CremaWduav,in s000cdwce vAh and subject to its Rules and ReWAabom to
Cremate the remains of
Philip B. Millington, Male
(Name) (g8)
45 Alden Ave. , Warrensburg, NY 12885
( ) (CRY) (State) (Zip Code)
who died on 3 r d day of Oct 2p__U
at Glens Falls Hospital
(Place) (Address)
Name and address of rat tivirQ reia we or name of person SUVK rM g cremabon:
Cindy Millington (same as above)
(Nam) (mi)
Relationship to the deed Spouse
Name of Funeral Home Alexander-Baker FH, Warrensburg, NY
IMPORTANT:
I represent that to the hest of my kviawtedge,the deceased(t"jar(has no pacemakw.deftnUator or mW other bettery operated
device in his or her body. (Cirde One)
I certify that I have AM power lion to arrange for the crematiort of the mesh and to direct the disposition of the
1by
rem ' y persona ossessions have either been removed or may be destroyed,and agree to protect,defend and
ne View Cram Irtrt from any and all dams and demands for loss or d enrages which may be made against them
of or eonriecled cremall m of said rams as dbecled,WaRier such claims or demands are or are not www
e or
Warrensbur NY
M+itrress) fAddrecs)
X n, ` 'ate : 02�me as above
(Slgnetrue and Address of Re ve or Legal Restive)
signed on mis oats: 10-6-0 8
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mall to
Other arrangements_Please speciN' F H will pick up
If pulverization of cremated remains is requested,check here X
Revision:
l8 f7Al 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 grourxffess,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 styno m or plastic containers will be accepted.
4. Cardiac pacemakers,defibrillators or outer battery operated devices must be removed
before any remains will be accepted-
S. 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 vAll be a_$26c00 charge
for this service. .`- -
6. Cremation, Administration Costs and Recording Fees:
Adult $388:06` 33v.
Children (age 13 months to 12 years) SISO-W
Infants (stillbom to 12 months) r- 130,
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