Bunker, Marie r-rn rMN
p F QUEE9 SB
. WE 'YIE`P� CEMFTERY AND CRE 1�
'R ROAD, QUEENSBURY MATORIUM
(518) 745.4476 tMW YORK 12804
(518) 745.4477
Funeral Director
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Case,
Gate Of Cremation
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Time Cremation Started U
Time Cremation Completed
Type of Container fJ
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Remarks
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Town of QY
Pine View Cyr wW CmnwWrium
21 Quaker Road,QumWxu r.New York. 12804
Cexneury OQ'ww 518-745-"76.Cmawftr um:518-745-4477
Authorization to CremeW
The undensipnad requests and suth ewe Pine view Cra wwrkm in accordance vft w d subject to ks Rules wO Repretiorrs to
awnweemmmebact
Marie Bunker Female
( ) (CRY) (SU") ($Code)
whodiedon Saturday, 13th dayof.Der_Pmber MOB—
,tIndian River Nursing Home, Granville , NY
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Name and address of�aft ralerive a narnr I of person
$„h„"D AIL,f
(am) )
ReWww*to the deceased mot- 5_43 U Cby%r�-
Nan*of FWWW Home Alexander-Baker Funeral Home
IMPORTANT:
i represent#w to the best of my b vwAedm the deceased(has)a(has no)Mmmokw.ddbMeW or any odw 6elis y MweNd
devlas in his or her body. (Chb One)
i certify that 1 have full power and mow t oon to=n pe for the cremation of the renufns and tp dtreet the dlepoeiUm of the
cremated remains pmwsdmu have ether been removed a rosy bs destroyed.and spree to pre.dalwo and
save View Crem cart from any and aO dab*acid demands for loss or dmTwgw which may be made apairret them
by or connected crenaetion of sdd rarrrebrs ss dbscted,vrfnettrerauch datrns ordemends smoram not vdwIy
false a r
(Vvitness) _ ( )
f
(SVnehn and Address of Rn Ww or Legal Represer t dm)
sipneaonniscww December 14, 2008
Disposition of Qemated Rwmft
i hereby direct Pine View CrqnwWWm to dispose of the smogftd rename as totiows-
now-Funeral Home will tick up.
Outer wTwvwnw is-Please specify-
if pWverizeicn of cmmWAd nwmkw is requested,check here X
Revision:41 r, �
/S f) ,07
ij
Policies, Rules a
1. Pine View is locaNdowtheorotdidsw Pine view Cemetery.The
�P . ' ;nth Frey. 700�to.�3; oprr Qrix telephone
a ri "at�rema�ns are rry. rr�rrgemers. .,, .
necessary cremations.
2. A ` signed by the nearest next of kin is necessary stating
anat they do and d d of the.`e for tho cremation of the
remains,that rW WwwPos4esskxis
have either or may be. troyed and agree to protect,defend and save
harmless Pi ie and Crematorium from any and all claims and demands
for loss of
Y be made skit th n by-,r i of or conrrecxedwidi
the cremator- id remains andlor di position of.seid remains as.directed whether
such claims are rat vigil►grritdteSs,false ortrauiiiufant,this authorfization in
addition to a 1 permit must accompany the remains.
3. All remains a casket or suitable alternate,container. Caskets;arid containers
must be of 'tile material. No styrofoam or piasticcontainers will be accepted.
4. Cardiac defibrtilatom or other battery operated devices must be removed
before' =be >:.
5. .:Cry ;w -deys. hours)of` afthe
pucral
;. '�,. .. ,� Al<rthorizatiorr=l�d�Cremate, rt.}:�thepdar�wiu
t#inee•ti ys of�C emat on Wftf� r-eraf home
handling .less other�e.M are made.There will be a-,J charge
for this
6. Cremation, Costs and Recording Fees:
Adult ,,..S wow . 33J.
Children (a el no Ift to 12 years)' $ l 90-
Infants (stil 112 months) O,OGM-
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