Vassar, Valerie "�O`74N OF QUEEN5BU9�
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
V4JCr%4' -
Funeral Director M�3 6LAuName Vt'-55cir Case # 3st�
Date of Cremation Ay4v) t" �T2�05
Time Cremation Started
Time Cremation Completed P✓
Type of Container �c.�rllj�a� �i�we(' _� sta'No CASE .
Remarks ;
M A IN Ou p h moues
2.30PF\
4-3
5
"'BURY
ov, OUEENS
PINE.VIEW G EMETFRY
_0P
Ouaker ftq& (),_,eensbury, Ne'w 'York 12804
'745-4477 (if no answ0f)
pl
)one
I C) C J�EW A'n_
ir, -,3ccordance with and subject
View
he unJersigned rewliests and ji)thoriz (�1,einatofiurn
its, S and Req ulatiorls toCrernale the rernains (.-0'
'
VALERIE EE
(SEX)
(NAM
AMC—TJIHLEIN MERCY
(STATE)
(GITY)
[wh6 died on day of
Fit e A�i.T eENTE$A6 A
S 0
Of person cr(:
relative Name and addi-ess ot nearest 1MV19
VAItAR I E"V S AR
1`tela6nshiT)to dece
lqamr�! of Funeral ..... LA _PLACID, NY
IMP(.�RTANT acerna�.er in his or her
rear. ent j at jo j.he bPSt of MY knowledge, the deo(i3sed
bodv,,' ONE)
- and
of the remains
n to arrange for the, cremation t1ave the I certify that I , ft1j, power and authonzaiiO any jjaj possessions have either been
to&6-ct the(10060101_� Of the Crel,nated remains. that -id ano f, , harmless Pine View
and avp
.)gree j,o protect, dpfei
removed of n.j�ay 1.)e destioyed, vhich may be made
T', mands for loss or damages V
frOn') 8nY and all clall G and de s directed, wl,jether
on ()f or connected with the crernati0f) Of S@�d rolnains a
again'st them by Feas �,ss, f,,�jsc, �y fraudulent.
-ids are re not WtIolly grOLIMIF
dernat OF a
L. 2310
PLACID NY
:
AMC—TJ1HLEIN LAKE pl
TTURE (.')F REI.A VE OR L.E.-,GA, I_ A1111) PJXX�r
(SIGITA
-2
Fiignr d on this ............
, DISPOSITION OF CREMATED R,EMAIN Z
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1 ertay'rtirect Pir?s?View C�rPrn; torirrm to rii;pose of the rrem cremated rcar7'rains as follows:
+
t ail to . ..._......... I"M.�.,__B.�._CLAEK�,.�INS.�_......�.......__..._.-...,__...___.___,.__.... _.._.._..�..�_�M....�....,...__..__w.��
w.
2,310 SARA -.AV �., ., k�
12�4fi___ ___. .__...._
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C tl�er arkangernentrv•Iaiease aper.;ify'.---_:._._.._._.._..__..�.._.-.�__._,..._.,__..__�..._..,...,....�......-......—,M.....
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If pulveri�aborr of cremated remains is requested, check here....__�.._ ....,
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pOLICIES, F4I.iLi~S ANI_r REGULATIONS
I
III The crematrari�arr,wiii be open fr:r crerrratic.�rts f; days a wee!<Too A.M. - 3:30 P.M. Nionday-
4 Fd4y. No Hchdays or Sundays, arrangements can hIP- madr ft7r Saturday. Pre-arrangerne;its
by t¢alephctne for acceptance of remains is necessary
J . Fine View C�rernatorium i> Irarated c)rr the grourds of tite F'tnc Vir,w Gerne eery, Quaker Road,
1"0w6 of Queensbury
ther
zed
3 P,i1 a 3lhori7��tion for c;rc�n7atihav�rthe {}c v,<�operiiy rlandsd ttas.tti?arityy the �to c)rrar c�c�fc]rresit the crc�ma�t7n afsth
(JF.1'5Cn ytetlrlg that they d
rernong and to di{�i�roivFecidr�r�rr7av beositiOrl r'dtlstrcayt�lrarei agreerto farotenq, that�t defend and aVe possessions
havFs.eitt+er hccn .
+ h�rrniess f�'ine View Crematorium frcrrrr any and a(i ciarm�> aril s�ie:rriands for loss or rlarnages
whtc;t may be trrade against.theca by ve ason of or connect:e�c} with ti"rc� crerrtatiorr of Said
rer�calr►s and Ic�r dislaoWutio�cofa4d or f cttdulentl�r'I"hia aukt�cnizat.ionther rin addition toh Clainis or day egr-nan�arare,.
s>r ark: not wholly groundless, false
b?sriaj permit: rnUsl accompany the rem'
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4. All r'crnain5 must be encased ina ca,l r.f c7r ,rtitahie alternrat.e coy+i:a.iner. Caskets an
contatiners must be of combust.ible, rnatc'nt 1. No Styr(.ftarn or plastic containers wHl be
Iaorepied.
Bumbe Question relative to caMhc pamnskers must be answerec:i on the authorization to
cremate form before the r-ernains will be wx,wPWd
G.I l..inlejs other arrangements c f r;�rrnad it�n trcti e?fcrera�
[Mail within ti"srs?e days teed
r�rt n some f�and}ing be mailed
he service,�Ti arc dwlll
by a $25.00 charge for tf'sis service.
C mmic:rb. Administration r C:osis and Recording Fee Adult $300 00 Ghiidren (age 13 morAhs to
Infant, §ti barn A) 12 n-,nr,khs) $100 00
" WNW $50 00 charge ox cremations done after 3:(10 I` ('� (v1c}rxlAy lltrotagh Friday.
C Ierrratioi h done an `aatr.trets�ys VJ01 be O'larcts d t! e ;�ctr�21`1�rl $60 0(),
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