Washburn,Janice Marie Pine View Cemetery $ Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME;
DATE A TIME REMgIry$ ARRIVED AT Cq[MgTORy. RETURN TIME:
y L ___
NAME OF FUNERAL DIRECTOR OR RECRISTER[D RESIDENT DELIVERING R
_._. - e'pAo
EMAINS.
NAME:
MOAC¢_ uasNao¢a
TYPE OF CDNTAINER - CASE #
PLACE OF DEATH: 235 • / AI}lfq}LE �E"(+M1Mr
Arta _..� 4!LA:
----- QL1j� zr�
FSTIMATEO WEIGHT OF REMAINS 8 CONTAINER "
PLACED IN _," II
NOLO; _ -�..�4 _
PLACED - --' --IN REFTNGERATIONZ "' -'-
PATE OF CREMATION
TIME ST
gRTED:
PLACEDRETORT 'I'I
IN QSE'1. COMPLETED; - YD -[y—
Ary —TME
JIM _. .-moveD: A A�RETORTS IN WHICH REMAINS WERE - -1� #
CREMATED: S4rdV
. " � n � � A1'
Of ACCEPTED DELIVERY
DETAILED REASON FOR DELAY IF REMAINS WERE CREMAT � .
FROM TIME EO S
MORE THAN ag "OURS
NOTE T;ON LO naLl o[ nergl NED IN 'He PERMANeM FILE OF THE CREMvopv
\ New York Sure
Nap o ter
SiLtEOE Division of MV610N OF CEMET es
OPPoRNNITV. Cemeteries As ehlewin Awnue
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Atithoriution for Cremation and Disposition
"Is Armremmron Form must he Compared and slgoed prior to"Ivey d MdMlm drorwheuan.
Date:OB/20/2020 Number loot
crematory, Nwdwl ne View Cremawdum
Anhui Ouaker Road Oueensbury NY 12804 Phone: (518)745-44T9
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
(bHntlion d Grtiac ON by placing Me remains of the dereesM ate Me Wmainer parer the remelts intoa mmatipn Mamner wham
they am aubpled to Intense Neat and flame. The Iwr and flame wall Indne eM consume eye Mo except nerve and mein,
which are all that will M let after cremetlon.
Following cremation, the aerosol WII UM reasonable elroM to remove all of Me remains and drum mateNl from Me operation
tanner, but some minimal Met and residue will burgy be let EehiM. The oemetorywill eelHred liw'vJeMel entl bM1ipp nbtelielfMm
line remains and the nominal and foregn matehel all he disposed of as required by me The amended remains will be mamarea ry
pulYenmdImo small pieces and placed into a d gne wmeinerw um creamedmminageneraltyatepulveda uream
dngMhpnnM Is rec n"ble Am skd ltl ue.
OPENING OF THE CONTAINER
The channel may only open Me cadmi m housing the un�cremaded human remains in limped circumstances such as to 6nhm Me
itlenMy,of the exceeded or to ensure that no mail packed which might injure employees or damage Me aemebry gcPony. N
human remalM am dellmmal in a comminwwnlch Is act suitable for dematle0 such as commanded royal Wi the
Mmedry wall require that me remains them n ed Imo a suitable academy metre N accepts Me remade.. me Mundane dad
consumer or Me transferor remmal d remains*,it m conducted maps a wereaf and wall redone a print wan dignity and reams.
IDFIInHCATION OF DECF ED
Name of Decreased Jamca Marie Washburn All Stever. Marred
Leal Known Ad s 2355 BurgoyrM Ave Apti Hudson Fells, NY 1M39
place of Dean. 2355 Burgoyne Ave Aptil Hudson Fells, NY 12l
Mae: OM ® F Age: 52 Me, 10/1441957 ImddD OWlWD20 bdmddw&pft 2W
Normal of raiumic dnor in whim rem.ins will mauYwW.
Alternativelfiberboard container, Mattheva Company
PERSON IN CONTROL OF O SPOS TION
(Farsonls)In mpria or dupov'dicn, NR WE dMe elkwmg)
I mMYa are the designated ant of the deceewtl tl nWW in a 411 awhen instrument emcude WnWm to PWIe
H MIYeS on 4201.
-0F.
I 'e he" Med9e Mat Me dd executed a written Instrument m M Field Health Law Sal 4201 or
mmeieng M doOM
dxecbOm for Me disammon of his Or her remains and Ilwe are me perform)hum papery under Public Healm Law
Set 4201 ate have 1M agMM Moderate chancellor ofMe remains of the deuaced. Sri releaonship to the deceased d as
Mbx :
Janice Marie Washburn
pownDi
I le f)Rev. 04120) Page 1 of
Authorization for Cremation and Disposition
(insert bmm fire list narrow)
Nummr: #2 Descnpeon'.Suraivinp Spouse
1. A Person designated in writing IsAwamto Public Heats law Shadcn e2111(g,
1 The surviving famous:
28. no aunt ing ocmesuo partner
S. Any surviving cold eighteen years W age or older',
A AfurvMy parent,
a. A surviving sibling eighteen yeah of age or older,
S. A Normally appointed ignition',
]. Arry grwhst eighteen"Sm Of age or older noted In share in the estate and who ;Care GONfl In relagonship to the tleadw ;
E. A duty appinted fiduciary 0 Me estate',
9. A does Mend or rotation who has executed a written MNmend pursuant at Public Hear& Law Second 421
10. A&iet Moral ofimr 0 a wuMy,or a public admldistrelor age morning to Me Sunc9ate a Court Procedure Ad:
1W. Ay Other own who is acting on owner M the dettased and who has executed a writlm statement pursuant to Public Month
Law Sealwi 4201(7t.
grabbod ALL THREE d tM1w taPowvgl
y
x l♦ lose hereby affirm Mal fire bot of tow dpeped does nor contain a battery, Mllery pact, Power Air radmadlve Implant,
or raPaedive dense and Ntl arty such matedak seem command anor to Me execution d this Anarormn Form. FaNun mmnovt,
Mae bane Poor no cramatlon my nsuh In harm b the cram and crematory mmnre .
wh afford that mstroure shw$men grant to _ .5mithhAA.�ilo
ream idg Me removal deny persorel p M or power Mire of Woe wirer any Person agrag bbw or any krrM nwKar NMe
bnsaad wi 10 preaere. Pine Vow Crematorium
is nett whereas far Me removal of r nektons barn Me wnmirer or ham Mdshadwof th dehoural Porwnal Home left In the
wnmlmor or when Me r m will be Moderated oy the cremation owns and cannot m renlavaa alter camaaon.
1xx1*N Howe hereby suumrize Pine View Crematorium
m.rnr mcomic Me ins of Metlxaesatl.
I mwtaPTCrWL)
Its hurt aulbrlaa the named lunar»almanac to prmvWa for delivery to and cremation by an Impose
add. Membrane!ry. itMembrane! necessary In its opinion of Me Nmral dlrecrmr,and m ammo Mls form to provhae the Mead name and
ress M such abmw cremaory.
FINAL DISPD5MN
The prsn ae trmiea to remNT Me mmWt micas of Ma MrlXW from Me crematory is
Name;Regan Denny Shorthand Funeral Home, Sarah A. Philp
Address: 53 Quaker Road, Dueensbury, NY 121 phone: (518) 792-1114
The command remains d de topic disposed M of follows,
To be retumetl to husband, Michael S. Washburn
of rot any rpsar May geological ndnwd abate Pen and take posufIX ones
reneva.
Pine Yew Crematorium reauMWZMfogM poaasmnd
gy remarmm Ragan Denny Staffif Furore Home by Mary
e"i
hpmpnelwmaanbad awk. � Janice Who Washburn
m .wmakia
WS-taloftw.o9R0) Paget W 3
Authorization for Cremation and Disposition
(NAal are romwmy
J� pet=NW understand that Odes remans an net Mainland vA1Mn 120 Nye of Freedom,
Pine View Crandatterrunn maydeWwdawremainam
an irrmle..bta manner, a0a as W xatlefrnt.
r�IONE of the Alumni
M on m be used as a container he vedman nmtlm na been WrUasad M1um Rein Nenny St¢Rord Funeral
and a deauibN as klbwn
Me understand that the um a too shed mMd the arebre vamsW romeina an additional fend anNlrer may Ire many for tannery.
-oR.
X 10-w MumienNyet WrNased. tM1Vewtlemend ffnoumispurNeeedurutlxmfae dW
PineCremabrium all gamma mematw ratmim in
ow
a raid bmpwary container for eavery.
noAuularkelbn Farm ways provned by Samh A. Phllo ,sic parppppM
u.m Re Funeral
Hgan Denny StaMord Funeral oma
53 Ducker Road, Queensberry, NY 128g4
and is stand by the funeral dheGm as overseas to is reticence.
W/e have reseivW a completed may mthis AuMonesilan Form.
no wrsunp)Idemi nd below Islam the pert in control M dssess ,who by agnhp bills AUMMeNon Form,aMst
W the accuracy and completeness Mtlhe Into rmadmn conned in Mh AuMwlaalpn Farm and aunwrizNs)the Mrepotng.
abmde ran2ft day of September x2 �
Michaell Steven Washburn
2355 Burgoyne Ave Aptp12, Hut Fells, NV 12638-
r�
rwsremar... em.rw
WrtXEss:
Sarah A. Phib
a..+a.a.nvmsnrrm.e �.+>irm mom
12889
Janice Marie Washbum
luewli
Mly-I& 61(Rsv, 0020) pops 3M3