Lamb, Gene Sr. `7 n`WN OF QUEENs5BURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director (4"'�a nctm
Name e-n -(- L-0,6 s-y. Case # 2S
Date of Cremation '11 1061
Time Cremation Started /c7'Zot:7
Time Cremation Completed 360
Type of Container
I
Remarks :
Nioui:-
I
i
i
it
i
I
i
I
i
I
i
Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road, Queens x", New York, 12804
Cemetery Office 518-745-4476,Crematm ium:518-745-4477
Authorization to Cremate
The undersigned requests and eudwtzes Pine View Crematorium,in SOMFUnce vAh arid subject to its Rules and Regulations to
cremate the remains or.
Gene R. Lamb, Sr. Male
(Name) (sex)
39 Glassbrook Road, Stony Creek, NY
( ) ( Y) (State) (Zip Code)
who died on llth dayot_ August 09
at-304 Pine -St. , Corinth, NY
(Place) (Address)
Name and address of nearest wing relative or name of person ainwrmV ciamattort:
_�►/�(C l{ACCbL4/7�
(Name) (Address)
Relationship to the deceased D 4bEbho%C r
Name ot Funeral Home Alexander-Baker Funeral Home
IMPORTANT:
I represent titat to the hest of my knowledge,the deceased(has)or(has no) ,dSftd)BW or any outer battery operated
device in his or her body. (Ckde One)
I certify that I utttottzatiot+toamir ge for the ae[ttetmrt of fife reraekas and to direct the disposition of the
cremated re rts,that any I pot orts bare either beers resoled or allay be des bgmck artd agree to protect,defend and
save Pine View kcal airy and ati and d for toss or vA*:h may be made against them
by of or yr h Ow crema gm of sa`.d rel na bs as duelled,vifa�suds d aims or demettds ass or am not vwttoily
g .false
(A'Wrwt3L%.
(am)
�4 175
( and Address of Relative or Leo Restive)
5agnea on tuts sate: August Y�;/i/ 2009
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mail to
Other arrangements-Please specity: FH will pick up
If pulverization of cremated remains is regwsted,c hecK here X
Revision:Jet�y�-290'
Policies, Rules and Regulations
1. Pine View Crematorium is lxated on the grtrL—ds 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 Crerroftf signed by the nearest tread of km is necessary stating
that they do have the power and aulSwifty to arrange for the cremation of the wins
and to direct the disposition of the cremated remains, that any personal pions
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 vAo#y groundless,false or fraukdent.This audxxtzation 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 stynAbam or plastic containers will be accepted.
4. Cardiac pacemakers,defdNmoors or other banery operated devices must be removed
before any remains wiQ be acoapted.
S. Cremations will be completed within three working days(72 )of receipt of the
Burial Transmit Permit and Authorization to Cie 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 charge
for this service. ,
6. Cremation, Administration Costs and Recording Fees:
Adult $38e-ff -33;1 �r
Children (age 13 months to 12 years) $150-W /;go- `D
infants (stillborn to 12 months) j,3 C,
C�r�27r,V!( C/Zr