Bentley, Joyce To W� 0-7 QU E E 9\�S 0 u rp
PIN$ YTEW CEMFTE'RY AND CREMATORTUM
�V-KkEA ROAD, Q(jgZNggV-RY, NrW YORK 17804
(518) 745.4476 (518) 745••4477
Fu r nera 1 Director
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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 Regulations to
cremate the remains of:
Joyce I . Bentley female
(Name) (SOX)
(Street) (City) (State) (Zip Code)
who died on 8 day of March 2009
at Glens Falls Hospital Glens Falls NY
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremation: I
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(Name) (Address)
Relationship to the deceased
Alexander Funeral Homes Inc. I
Name of Funeral HomeI
IMPORTANT: maker,defibrillator,battery,battery pack,power
I represent that to the best of my knowledge,the deceased(has)C (has no)pace
cell,radioactive implant or radioactive device in his or her body.(Girds One)
I certify that I have full power a n to arrange for the cremation of the remains and to direct the disposition of the
cremated remains,that rsonal ions have either been removed or may be destroyed,and agree to protect,defend and
save harmless Pi iew Crematoriu any and all claims and demands for loss or damages which may be made against them
by reason of connected with the motion of said remains as directed,whether such claims or demands are or are not wholly
ground false or fraudu
(Witness) (Address)
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'(Si ature and Address of Relative or L al Repr tative)
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Signed on this date: R.
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Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
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Mail to N/A
Other arrangements-Please specify:
funeral home will pick up.
if pulverization of cremated remains is requested,check here x
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Revision:January 1,2009
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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
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implant or radioactive device must be removed from the body before any remainswer cell, I �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 $350.00
Children (age 13 months to 12 years) $200.00
Infants (stillborn to 12 months) $150.00
Overtime Cremations(Weekdays) $550.00 f
Saturday Cremations $550.00