Steele, Athora Pry VTE J QUE2�
VV CEMETE �L
QUAKER ROAD, RY AND CRE '. y
M
QUEENSB ATORIUM
(518) 745-U13 �Y' NEW YORK 128C4
(518) 745-4477
Name
Funeral Director
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Of Cremation
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Time Cremation Completed
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Type of Container
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Town Of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road, Queensbury, New York, 12804
Cemetery Of5ce.518-745-4476,Creruatoriurw 518-745-4477
Authorization to Cremate
m�f 84 wrtaez Pine Viesur C tociuta, with OW to Its Rules and ReWdedpnq to
Athora A. Steele Female
(Name) (Sex)
1 ]�4 Chr�rman AvP (11tPPnchiir..� NV 1 �n4 Greet) (QtY) (Stale) (Zip Co_de)
who died on 19 t h day of October lv 09
at The Stanton Nursing & Rehab Center
(fie) (Address)
Name and address of nearest tieing refatiye or name of person auanorztg cremation:
Linda Tennant PO Box 306 , Warrensburg, NY 12885
(Name) (As)
Relationship to the deceased Daughter
Name otFuneralHome Alexander-Baker Funeral Home
IMPORTANT:
I represent that to the best of my lmowtedge,the deceased(has)or(tom no)PaCMUAW.dsftdlatW or any other battery operated
device in his or her body. (Circle pne)
I certify that I have fill power to arrange for the coon of the Maeft and to direct the won of the
cremated led remains. Y pew have eMW been removed or mW be dasMWed,and agtea to protect.defend and
save ttarirl Floe brew any and all CWns and demands for tags or dwragn wNch any be made against them
by of or connected wM aernedart of sa!!reirmb as directed,whafm s dh clahns or dasrands are or are not wholy
9 .false or fiat ertE
L ZEwr'/�ul�-6
} (Add )
( and Address of Relative or Legal�)
5igneoontnisaate: October 20, 2009
Disposition of uremateo Hemarns
i hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mall to
Other arrangements-Please specity: F H will pick up
If pulverization of cremated remains Is requested,Cheat here X
Revision:J4gLy. 4
l
Policies, Rules and Regulations
1. Pine View Crematorium is lxated on the gro rds 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 Cremafi "signed by the nearest next of kin is necessary stating
that they do have the power and audm ity to arrange for the cremation of the remains
and to direct the disposition of the crerrrated 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 wtwNy gam,false or ft8U*AeM.Ttlis auembation in
addition to a regular burial permit must any the remains.
3. All remains must be in a casket or suitable alternate container. Caskets and containers
must be of a combustible material. No styrvfoam or plastic containers will be accepted.
4. Cardiac pacemakers, deiibrators of othW battery operated devices must be removed
before any remains will be accepted-
6- Cremations will be compkAed within three vying days(72 houm)of receipt of the
Burial Transmit Permit and Authorization to Gate Form.The am remains will
be mailed via Registered U.S. Mail wtthtn three days ated of cremation to the funeral home
handling the service unless other arrangements are
for this service. made.There will be a Ueoo charge
6. Cremation, Administration Costs and Reoorcf"ing Fees.
Adult $30@n( ' 330. .:•
Children (age 13 months to 12 years) -$1a8." f;90-
Infants (stillborn to 12 months)
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