Kreinheder, Edward T0J+N OF QUEEN4,5BU9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director "'ne&l
Name Case #
Date of Cremation (2�2.3/0g/
Time Cremation Started 7,o o ,
Time Cremation Completed /0,304'iffN
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Type of Container (� C
Remarks :
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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:519-745-4477
Authorization to Cremate
The umdersigned requests and authorizes Pine View Crematorium in accordance with and suhied to its Rules and Regulations to
cremate the remains ot.
Ql,t ,o L . Kne-IA"e Male
(Name) (SW)
3922 Main St. Warrensburg, NY 12885
(street) (may) (fie) (Zip Code)
who died on 19th dayof June 20 09
at 3922 Main St. , Warrensburg, NY 12885
(Placle) (Address)
Name and address of nearest living relative or name of person audmrizbv cremation:
Carol Lorrain 3922 Main St . , Warrensburg
(Name) (Address)
Relationship to the deceased Daughter
Nameof Funeral Home Alexander-Baker Funeral Home
IMPORTANT:
I represent that to the best of my ivwwiedge,the deceased(has)or(haa:no)pacemaker.defibrillOW or anY other battery operated
device in his or her body. (Cirde One)
I certify that I have full power and authorization 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 or damages which may be made against them
by reason f or connacted with the cremation of said remains as directed,whether such cleirtts or demands are or are not wholly
9� � ar
3809 Main St . , Warrensburg
'
(Address) r /
� � a �� Sf 94 0 4f,'er
(Signature and Address of ReWft or legal Representative) 11�I�kXZ
signed on this date: June 21 , 2009
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as Idiom:
Mail to
Other arrangements-Please specify: F H w i 11 p i c k u p
If pulverization of cremated remains is requested.check here X
Revision:4AW�
/8/1PR 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 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. Cardiac pacemakers, defibrillators or other battery operated devices must be removed
before any remains 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$2&.00 charge
for this service.
6. Cremation, Administration Costs and Recording Fees:
Adult $380.-W 3: 0
Children (age 13 months to 12 years) S45G.W 190-
Infants (stillborn to 12 months) °"'
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