Flagg, Bessie r-'""n'7/tN OF QUEE9�S0U2r
PLNE VIEW CEMFTt'RY AND CREMATORIUM
��`VXkRR ROAD, Q(IEgNS"PlY, NEW YORK 12804
(518) 745.4476 (518) 745.4437
( _ Funeral Director
Name
' . Ca s e#�. --
Dace Of Cremation
Time Cremation Started
Time Cremation Completed
Type of Container
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Remarks
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TOWN OF QUEENSBURY
PINE VIEW CEMETERY
aG
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 745-4477 or if no answer
Cemetery 745-4476
AUTHORIZATION TO CREMATE
The undersigned requests and authorizes Pine View Crematorium, in
accordance with and subject to its Rules and Regulations to
cremate the remains of:
BESSIE FLAGG Female
(Nsrme3 (Sex)
70 Cedar St. , Tupper Lake, NY 12986
(Street ) (City) (State) (Zip Code)
who died an
7th day of December xx%2008
at AMC iJihlein Old military Rd . , Lakp Plaf-id , MY
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation:
Glenn Flagg 70 Cedar Street, Tupper Lake, NY 12986
(Name) (Address)
Relationship to the deceased qnn -
Name of Funeral Home ;�� R riarlx Tnr 27 Raranac AV`n1 '3
Lake Placid, New York 12946
IMPORTANT:
I represent that to the bust of my knowledge, the deceased has or
has no pacemaker in his or her body. (Circle One)
I certify that 1 have the full power and authorization to
for the cremation of the remains �rsonal direct
possesstons disposition
either
the cremated remains, that any p
been removed or may be destroyed, and agree to protect, defend
and save harmless Pine View Crematorium from any and all claims
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 not wholly
groundl ss, false or audulent.
Mill Pond Dr. , Lake Placid, NY
(Witness) (Address)
` 70 Cedar St. , Tuooar Lake, NY 12986
(Signa ure f R Live or Legal Rep. and Address)
Signed on this date: Dec. 7, 2008
DISPOSITION OF CREMATED REMAINS
direct Pine View Crematorium to dispose of the cremated
as follows :
rangements - please specify kicked lip by fun"1 director
!rization of cremate remains is requested, check here
POLICIES, RULES AND REGULATIONS
1 . The :rematorium will be open for cremations 5 days a week 7 :00
A.M. - 3 : 30 P.M. Monday-Friday. No Holidays or Sundays,
arrangements can be made for Saturday. Prearrangements by
telephone for acceptance of remains is necessary. *
2 . Pine View Crematorium is located on the grounds of the Pine
View Cemetery, Quaker Road, Town of Queensbury.
3 . An authorization for cremation properly signed by the nearest
next of kin or other authorized person 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
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 or demands are, or are not wholly
groundless, false or fraudulent. This authorization in addition to
a regular burial permit must accompany the remains.
4 . All remains must be encased in a casket or suitable alternate
container. Caskets and containers must be of combustible material.
No styrafoam or plastic containers will be accepted.
5 . The question relative to cardiac pacemakers must be answered on
the authorization to cremate form before the remains will be
accepted.
6. Unless other arrangements are made the cremated remains will be
mailed via Registered U.S. Mail within three days of cremation to
the funeral home handling the service. There will be a $20.00
charge for this service.
Cremation, Administration Costs and Recording Fee: Adult $195 .00
Children (age 13 months to 12 years) $115 .00 Infants (stillborn to
12 months ) $75 . 00
* Additional $50 . 00 charge for cremations done after 3 :00 P.M.
Monday through Friday. Cremations done on Saturdays = will be
charged the additional $50.00 .