Nemer, Cheryl l'iltc Victt' C'12I11u(:l �' c\ C;I clli;llc>riulii
)tiakcr Ro;ul
Q(Iccllshm y, NY 1 `l80d.
0 1 8) 7�1.,i-�1.�1.7/ cll (,518) l�l.•'> �I I.7(i
Ills l;ll I-lolllc ... ... ._ �.... KZ.�1'�!�
ItcclIIc.Ic(I Ilclti I tntc d
-
... _ NO. 3
I);Ilc of (;rclll;tlic�ll -11?0 1�7.__....... I Illlc .til;ulccl 7:IO � I Inu CJ)IIIlticiccl_ l� Q
Phcccl ill Hold:
I'I;ucc1 nl 1?clr1�"ci1111011.
I'I;tc'cc1 in Reim l:
Typc of Coltl;tillc;r .. .. fl �► .. .I}
- La1TO _. .
Rcnl;u'I:a
I\�lail,
---- - - ---- - - ---- - IN/l ovc
-
PLIcc of
I'sliltt;ltc:cl \A/cIgIII of Rcm;tills ;kIId COIII;tiilct jl J
Dille & TIIIu; Rclll;tills ;I rit'cc1 ;II C;rclll;llctrp...
IIJ;tlmt of Funcl;Il Dil cc•lol' or Rc;jslcrccl Rc'siciclll ill; Rclllnills
Doallccl rc;Ison I.ov cicl;ty it lcillailt> tvc:ic ctc: u,ut:cl iiluic ;li ut I lutnt. lic>ttt
cull\'(;I'y
Rc'tott Numttcr it, tvl tit It Rcttt.tttt. Ci l
Nolc: •I lu C:rciltal1011 l o' slt;tll I,c rcl:tiitc cl Ilt ti c l c•tttutIwIIl I"ilc'. ctl Iltc C lc:ttt:ttctr�
` odAWLgi7 14i41 711J/4./04d NSKII.MER PAGE 01
Now Y(rk lot@
"�rvRK QlVtsIon of °"""'"""'""'
N� /� DIVOWN 91111 MrTIlftll�Ii
ORQRTOUNtTtf. C+�m4ftrtes One t7et g"A rtua
1 fi Wrhln�n Awnup
Albany,W 122314001
Ydsphone:1511)4?44224
www,dos,
AuthorlWen for Crernatlon 4nd Disposition
ndo 44ONWMaf40borer moil be eempleMd end vipted pdw to dell"ry of remains for otrmet am
Faa,10 1011
Cwmstory Nance,Fine View Crematory
Addrap Quoksl Roil,Quwoabury,NY 12106 .�...�._..�r .._ . PNns 1516-746.4477
CtItrNAT10N li AN IRwilllRiMlL!AMID/INAL NMI$.
Cwmatbn is carried out by plaClrp the ntnraina of Mu deasasd end M+e ce>f+tatner holding the romans k►to a;rmatron ahu wt nl»r w e
M»y are eub}emid k1 ttltsrree Meet tared Aar1M The Meet and fleaw will ImInerste and consume MYerytMnp eKcW bone and metal,
hk wh are so#0 wilt a Nell a1Mir efarnetttan.
Following aen»tion,the a'emtpr)r e 041 take reesonabfe offnrts to remove all N the remains and ottlatr mab"im tram the arrnation
chamber,taut some minimal duet and midue 4 likely tee left behind The orernetary wlli separate ino,dental and foreign material fro'n
f ttn remains and the Ineldvft er10 Wolp mal erMl will be dispow of as rogOrsd by lave The Cramatad ranritna wril be rre018nicapY
pt M dzed krto small places and placed low a daalgnatod cor0kor or urn. Crenfetsd rseralns gerNraliy an pulverised until no
Imp Mime is nowlrabia as BMWI tMew. ...T
he�ry�on y open t e container haidingp the un-cremated human fWairt A limtt�ad ckamiUnaa,veer+q to ain'�m the
idenilty Of"dwsood orb insure that me motemol is enoloeed welch might injure employees or damapa the ammatary property It
human rerealne are dlellwfee In a tombinor which Is not•uit•ble for sremalon eueh M eeremonlal or rental Wket,Via
erernaeery will roory that the rornatne be reeved Into a evnaOMl M481 sr before it accepts Vw remsine. The openi of a
contalnar or the transfer or m"oval of wmsims will be oundUCtad tesfore a*knew and will be dome in pMvacy.with dipnfiy e++rt respect
Name of Ososstaed:Cttstyt Noff e--_—_�__ --------- ------.-- Marks,Eta" Merri«t,,_... .,...
Lost Known Addraae'30 Miller Road,Argyle,NY 1200
P"of Dow:owns fails Nosefti, 10D NA Sheet,Cblans falls. NY 12W I —
sex; 0 M N F A";f Doll.a topless Oats of Death:�tU201p W EatlnreMd VWiprt, 00
Degoriplion of cwk0VW%iner In which MR1404 will be OVIN O
Mlnlmum Cremation Ceattat,Florence Casket Co.Cafdboardlpinelow WROM
ev A QW 0 �Ol �tr Of live k✓ o iv)
t&RW%are the dealgnelad agent of the deaessed do"neted in a will or written in#mnero executed pureuartt to Public
Haaklr Lardaw Socl m 401
hive n0 mpowiadge that the donessod oxwtded a~lnstrurnent pursuant to Pubbo health Law Seolion 4201 or a
u for ainlnp direolions lar the d'spoatdon of his or her rernalls slid INA ere the person s)having priority under Pubiie Neekh law
t oobom 4Za1 end hey*the►fight to authorise orema m of the m .afM of the deosssad, Vur relationship to"deweeed is as
telteMia:
Oharyl Narnsr
I
DO$-1a0a-f(Rev,0405) Page 1 Q13
I
I
vsr�o/so�a tear alrliai;a4n MttKll�'ltFt PAUL 02
Authorize
tlon for Carnation and Die -loon
(where fiwn ft sm grow)
Nwtftr..2 poiseriotbn.K�nrly�rpt Spouet
1• A persondea rhtlng igne*;n w punwsnt to p*ic tissitS
2. The Wr'Mrp apour; yaw t;votlon 4201(3): w
?a. The SUN MAC dOM111sild partner,
3. Any auremnp 011dd eipnseer years of ages or Door:
4. A aurvhving fyarant;
ti. A Wrvivina sWrq sightsan ysara of age or GjW
0. A*^Ily itppofnw quarown;
7. AI. A7lnn(s1 Nan wan of op Or older dn#Wd b�In!»aatnq and w►w Ware oloaat in relationship to the dacsawd
!, A dab felt I a of Of is Who nN tW s wrillen ela0tlnent purwant to Public Hoefth Law 1110o on 420(7),
�0. A olrlN Rsoel ouloar dt a county or a Pubic aeministrator oppokied pUnLant to VW gun�'y Court Prvaedura A,4
104. Any other pa►w who is aaktg on WWf of the dtsoealed and as ex#V te
Whb d s wr►ften atetrnenl puraaan IDpuDlia hiradh
Low Sebtlon 4301(1).
tFIREE of Me ftfiow/npJ
IA0%hereby a>hl m*Wt the pOdY of the doaeaaed darn not oonnrn a Dowry,battery pack,rg wr 0841,radtvaaove irnPlarK.
or radiesONvei deva and lhot any ouch motional weiris removed prior to tht 494VA n of this Atr*4r1nftn Form. Fellow to remove
tfttss Name pAo►10 tntnatlte racy rseuit 11r Mrm to tltt srematsry and rnamaaory personnel.
a m►that instaobons have been llvin to Too 0,
reparoing tee%moveh of any pomnal property or Oftr thing of vokA which s,q q►raon signing below or any fermy momoOt of the
deop"14 W""to prreona, Pitts Ydew Crtmstory
Is not rospariebw for tee►removal of personal Items+rom tie aMlsiner or from the remans of trio dows sod Personal IMrns left In the
eon4riner or tulip ft remelms V01 be dertroryed by the crtntetlon pracees and cannot be muievad abler ors#j"n.
W the heh'eby Nrdwale twine View Cronetory _
1* m Of mall Of fwrtlea of the does"".
NAL
allm
MT poftm outs hho d to receive eM U*rns ed rr mains of the dsaeW from tee oremstory It.
Name M.S.Kilmer Funeiral Horns
Addrsss 123 Main Street,Argyle,NY 1240 phone. 010-8364210 �
This o wnatso remslns of deceased will be dispoasd of as follows-
Re*W to Ti tsny and Fno
If for any roaeon Utt person named sbOve does not aka possewcin sf the cnrrnoW remains,
Pine View Crematory is Wei rmoo to give poanvon of
Ifta rwnMrq to M.a.Kilmer Funorel Ho" I
._......._.�......,..�....__ ..._ qy dst wry
rn person ar by mol led mill.
Cheryl Namar
DOS-ttl W(Nov. Dells) Page 2 of 3
I
I
♦ f
• ---- _... . .,., ww non«.r�R PAt1� 1J3
Authoftodon for Chmil on snd IOPOO tlon
undmwnd out if the fomamr era not cls,irnad wia+h 120 Wyr cnmador, may disp "of tM rama+M+n
Mrw View c"Oto"y
a/4*rnN1
sn irratrisvois ff*MMN such n pY saaaarMg.
QuOW Of""MW(W � M.S.KNmar FJWVl ire
An urn V DO used ara oonts,inor 10f ON C mfW mmelra has WM
and to orsc►ib.d as 1bNoNn;_,_.
Ir1IVa undr/itind owl M go um is 10o ernes,to hold the env*crsrnatad romallr,an addiaanal rlpid ocnt8+rwr may bs uarid for tNUvsry.
O
An urn Is not yet purohaaad. ihYY unds,►staid that If no urn 0purohasad Or othlMMoo provided
Pine VWw CmmaWy wdl pleas the oralt�oMd rarnsios in
fllr��dCrM�rW
a figri tamoorory oontalnW for do+Ivwry
This Aumook iiii en Fenn Pia vmvrdod" Tadd G Ntmrr
r.W,.dcMlamlAYnW
MA VJW"r Funaral HOMIN
lrww war NMIN
Twoodaropa,NY
end is 61114d 4 the furimm dkeorof as W*W#to its 00400n.
14W navy mWod Is a mpWad copy of this A&#O Wit*O IOns,
The I►orNWO)Nts,nt"bolow WOV the parsoh(o}In ooMml of dlapaNtion,who by signing this,AvOo dawn FOntt,attnettsl
to fhs aoourroy and CompNirnsao of ft infenn Non aontrined in this Af IMM0ilon FOrm snd authorlio(ti)tho"ping.
sigma this��._ _.__day of F'slsuary 1��,
0"Namur
-------
15 Abo im SirM,AO.Z,TIC W*ropa,NV 1Z11tl3
�......,...
WW
Sam
mopmow'wow
h ar V.'nini���
`r./ +.....
Cnsryl Nsmar
• .......,�.....6rY�darrtr��lE
006•1 W4(Rev.01m 5) Popt 3 of 3