Braynack,Nancy E. Pine View Cemetery g Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745.4476
FUNERAL HOME:
--__. RETURN TIME:
DATE S TIME REMAINS ARRIVED AT CREMATORY:
7LI i---gin "c`0,
NAME OF FUNERAL DIRECTOR OR REGpI$TERED RESIDENT DELIVERING REMAIN$:
—.— DA.g ALEr ooFv
NAMEt ! II B(A YACr
CASF D _ 93L
TYPE OF CONTAINER: N4 F9"
PLACE OF DEATH: .,_ "Didr P JE fl h`_ e
ESTIMATED WEIGHT OF REMAINS A CONTAINER 170 ow
PLACED IN HOLD: — iZ
PLACED IN REFRIGERATION:DATE OF OF CREMATION:
TIME STARTED: __ TNIAp TIME COMPLETED: ,
PLACED IN RETORT: __ T'I%M MOVED:
RETORT p IN WHICH REMAINS WERE CREMATED:
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 43 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOO BNLLL BE RETAINED M THE PERMANENT FILE OF THE CREMATORY.
NEWYORK p.wl NIYO Now,
STATE Of Division of OMSIOry OFCEMETERIE$op
TUNlry_ Cemeteries g eCemmnre oleo
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Authodution for Cremation and UISPOSition
This Au(hm/aation Form must be completed and signed prior to Delivery Of remains far crOm Lion.
Dam: 07/18/2020
Number:_ gp
Crema dy Name: Pine View Crematory
Address: 21 Quaker Rd., Queensbu
Clahad"0t11S AN HFUNNER%IBLE ad FINAL pROCESB.
C reon la carted oN by delang Me nm nra 1Me dau¢eE and Me da"MrM1opmg Me nmaiw lnbeuemafm cM1emberwMm
111ey subjegNto lnnnse heel antl flame. Tly Mq aMflamewill lncinereN and core
remains eacaptbone andmMS
M1kM1 en all an
ad I b lea*R rCmm M n.
FONowing pemadon, IM uemalory wNl lake
reasonable¢Pops to remove all
or five
remains and o1Mr malenal(min Me cmnepon
l]lember, but some minimeldwl end R¢idue vnll likely to kll6eMntl. iM1ecremelory will¢pareh lrmyeMel end loregn maler;al hen
MB remains and
MC intldeMal eM Mei9n mMenel will be dieposM of n repaired by law. TO cremated r¢mavu MII be mecM1eniplly
51 "Mep,Mo smell pines and plamid into a tlsagnemd CoMa,Mr or um. CmmM nmatm gamily am Wlart be
slrpm fragment is rengniends as akebYl tle¢w.
9 PEN
NLThi
i0 ndlr of ma Eeme.ee own 1ne annual
erro mladllsn material
elwbcep Iwl�i¢M1llrnmgm mi n ad emp�oreea areazme'•n me mmemmwrlfirm Me
M1Maannmalru am dslNerednlna wnUinerwIlcI ie na[auNebm br cremMicn¢ucI as cenmonal thor rentalc ry ph Mar II
marry will
require gut tin Rmains be moved into
a aulmhM wnYlnw bemn d accepts Ma remoim. The,Mai mnminera IM1e Iryn¢reror remmal orrem.;na rill be wlMuged belOre a wnne¢saM an be pone m pmacy.wIM hi,niai and reapeq.
IDENTIFICATION OF DECEASED
Name Of xessed: Nancy E. Brenack Mental suss. Married
lee Known Addreu. 4853 Stale Route 9, Wanensbulg NY 12US
Rem or peen: , M53 State Route 9, Walrenaburg NY 12885
se:: OM IN Age: ]] Doe: 11/09I1942 Data apmt 07/14QO20 Emmalad MMgb: 120
Description M wBkWwM,ner In "Ich remains aril be delivereal
New England Cremation deluxe cpMairrer
PE
(Persgr(s)ln �yE OIIlre ldbvnr9l
HwIM _SR Serraft am Me designated again Of five n e dea¢ed de¢ignam aril tl in a or within in¢Wmenl emceed pursuant to Pudic
jVFQ MAM have no knoWsdge Mad the de¢aaed emOsed a written IwlmmMl pursuant m Puek HeaIM Lox Section 4201 or a
will containing dander a for the dmpamion Ofhis Or her Strauss and IM2 are the parswts)having Pw*under Pubic HwW l.Hw Sec'dan0201 and heve Me Whi foal Opzevmadonate Mna;nsul Me deceased My/Durmiatlonshiptol d sedkas tllewa:
Nanq E. Braynack
COS-18984(Rev. W20)
Page t of 3
Authorization for Cremation antl Disposition
llns.n dose Re ratbarow)
Number DeanpYon:$NNIVrep Swum
1. A produce designated in writiig punuanl W Public Health Lax Settle 430113A
surviving spouse:
L. The summig dommusim banner,
3. My contrary child siffeed Years of age or dider.
0. Asurcvin9 Wrest
S. A suremng abling eighteen years OF age Of tie,
S. A history eppvnMt guardian
T. My pnki eighteen Years Of age or Year ended WMre in the di and who iyart dUBet In Matexamp to the demaand:
a. A duly appointed fidu[iary of the assume;
9. A dose MMtl or INatiw who has exeWb]a written submed formed In Public Realth Law SMro0 4201(7)',
10. A Chill deal WlKer of a mainly or a public administrator apponted purame to the Sun]ame'a COun Pmgdure Ad,
100, My Other Pormn who is acting On behalf of the deceased a no who has exemud awdum commend purswnt to Public fixed
Lew Section 4201d71.
SALL THREE Of rlre Mlowirp)
IA4e 1pnby Whom met the beer Of the dema lem net contain a Mllery, Mary pxk, Power Lid,MOarve lmmam,
Orndloadve &we and then any suchnuenals were emoted pfiorto the execution ofmis Autl zagm Form. Failurebnmwe
them ROM prlmm cr vdOn may mend In harm to dM cmma and Mans" personnel.
iSg Me affirm mat Instrudima have been that David Alexander
ngamIng the remawl of any personal pmpem or Other hing Of value which any Eamon siring below an ant rarely memlbr W the
dace edwlsheslOPexrva. Pine View Cremate
Is hot remo ide for the removal of personal items ham the Mother or Ramm%mains of he dena¢ed. IwdAwmllbmcleninthe
ycontainer or wise the mail will be da9h by M cmmatl prmMm and cannot be Mdmad after duraion.
r41�9we hardly aumorrae_ Pine Uaw Cremate
r
W cmmab she remains ON the 0aoed e0.
(Imrel OPTlONA1J
Rwd hemby Whonde the named funeral director W provde for delivery b and cremation by an albmab
address
Crarmo Of such Wiftern y
secessary cremate
a O of M funeral diration, and to amend this form to provide m rre e common name and
ateFINAL DISPOSITION
Tinpersonamhor to rewire are demadN remains of me deceased Mh the cremeWry is'.
Name:Alexander-Baker Funeral Heine, David Alexander
Address'. 38M Main Street, Warrensburg, NY 12885 Plans. (518) 823-2085
The nemab0 rmrems of dem9md win be deposed or as subdi '.
Return t0 family
It for any reason Re M mn iu'ned above don net take mammon of the cremated former
Pine View Crematory .aumeeree W give successor of
rc.�.twa.m
the MM"0 Alexander-maker Funeral Home bydbleary
in Perms Or by regabnd man, mom.. sew Nanny E. &ayni
mew
WS-1596f(RE"Cacti Paae2 Of
Authorization for Cremation and Disposition
(NeSe Mat endowing)
Me undentaMihM If IM remaim are np daimetl when tp days W cmreadon
IsiniliVa"Crearmatory
an 'mMevabk reamer, WM as by seaaeMg. � met date of Me remain¢in
CRFzs ON CQWMNEMURN
I�ONE aahe and whi
An um to be used as a container for Me aemeua rareins has bean invommed tram AleXander-Baker Funeral
am is Racnbed a9 follows:
Me understand Mat Me um is MD small b hold Me"m oRnleletlm ine, an a3]nbnal %4 wn4Mr they be uNd be deivery.
jf-dORR[-(
AnumlanNye(puMe . (Ane undenend May rchas um is pu�ased or therv.e pwgetl
Pin e�t/(BW(`irBnlat will home the cremeyed bream¢ in
m maid tengpary wMainer be daurery.
This AWMm FO=am provided by Daub Alexander sews eewyNm
Alexantler-Baker Funeral Hama
38M Main Street WarrenSbur9 NY 12885
and is signed "a Nnenl drtcbr as wilnaea to IN erecution.
IAve have 9ceivM a wmpl6yab ropy N this AWhw ""Form.
The Presnts) identlfied below Ware Me Mari in control Of dishaliton,whe by signing tie AmhWirsNlon Feem,ad 4s)
Mat accuracy mM cwnpbteneas of the InbrmaWn combined In this AUMonmafbn Form and autorimat Me foregoing.
Signed Moe 18M May by July , 20 20
George F. Braynack �.pwr F �ryyNytp6,/{
4653 State Rlwle 9 4Naifeneburg NY 12885 of V
WlINE4s:
David Alexander
m . M
10034
Nancy E. Braynaok
pm..wa....e
DD5-189"(Rev. 0,MMn - PW303