Mahar, Christian Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 74.5-4477 or (518) 745-4476
Funeral Home
Requested Return"rime__ NONE-__
Nance-----����i�� L----------------------------Case No. ---------- / s�
Date ol•Cremation 11 i l I i� "rink suirtcd _"rime Conipletcd________ ZO11
--A--
Placed in Hold:
Placed in Refrigeration: _----�
Placed in Retort:
Type of Container----___----Lr51�
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Remarks
Main ---------------------
---------------------------------- Move-------------41 Place of Death
Estimated Weight of Remains and Container--________ My I bs
Date&Time Remains arrived at Crematory -)________________ /(old �_30
--- --- - - --------
Name of Funeral Director or Reg*stercd Resident. Delivering Reinains______t--Ss�
Detailed reason for delay if•remains were cremated more dian 4.8 hours from time of accepted
delivery
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Retort Number in which Remains were cremated___
---- -- ---------
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Note:The Cremation Log sliall be retaincd in the Permanent, File of the Crematory
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New York State
Department of State
rNEWYORK Division of DIVISION OF CEMETERIES
STATE OF One Commerce Plaza
OPPORTUNITY. 99 Washington Avenue
Cemeteries Albany,NY 12 2 31-0 0 01
Telephone:(518)474-6226
www.dos.ny.gov
Authorization for Cremation and Disposition
This Authorization Form must be completed and signed prior to delivery of remains for cremation.
Date: 07/09/2019 Number: Y��
Crematory Name: Pine View Crematorium
Address: 51 Quaker Road, Queensbury, NY 12804 Phone: (518) 745-4477
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremation is carried out by placing the remains of the deceased and the container holding the remains into a cremation chamber where
they are subjected to intense heat and flame. The heat and flame will incinerate and consume everything except bone and metal,
which are all that will be left after cremation.
Following cremation,the crematory will take reasonable efforts to remove all of the remains and other material from the cremation
chamber, but some minimal dust and residue will likely be left behind. The crematory will separate incidental and foreign material from
the remains and the incidental and foreign material will be disposed of as required by law. The cremated remains will be mechanically
pulverized into small pieces and placed into a designated container or urn. Cremated remains generally are pulverized until no
single fragment is recognizable as skeletal tissue.
OPENING OF THE CONTAINER
The crematory may only open the container holding the un-cremated human remains in limited circumstances, such as to confirm the
identity of the deceased or to ensure that no material is enclosed which might injure employees or damage the crematory property. If
human remains are delivered in a container which is not suitable for cremation such as ceremonial or rental casket,the
crematory will require that the remains be moved into a suitable container before it accepts the remains. The opening of a
container or the transfer or removal of remains will be conducted before a witness and will be done in privacy,with dignity and respect.
IDENTIFICATION OF DECEASED
Name of Deceased: Christian Patrick Mahar Marital Status: Divorced
Last Known Address: 12 Arber er Drive, Queensbury, NY 12804
Place of Death: Albany Medical Center, New Scotland Avenue, Albany, NY 12204
Sex: ®M ® F Age: 50 DOB: 12/07/1968 Date of Death: 07/06/2019 Estimated W ight:
Iq >_
Description of casket/container in which remains will be delivered.
Matthew Corrugated Cardboard
PERSON IN CONTROL OF DISPOSITION
(Person(s)in control of disposition, initial ONE of the following)
I am/We are the designated agent of the deceased designated in a will or written instrument executed pursuant to Public
Health Law Section 4201.
Z
ave no knowledge that the deceased executed a written instrument pursuant to Public Health Law Section 4201 or a
ctions for the disposition of his or her remains and I/we are the person(s) having priority under Public Health Law
ave the right to authorize cremation of the remains of the deceased. My/Our relationship to the deceased is as
Christian Patrick Mahar
(Name of Deceased)
DOS-1898-f Rev. 08/15 Page 1 of 3
( ) 9
Authorization for Cremation and Disposition
(Insert from the list below)
Number: 3 Description: Child
1. A person designated in writing pursuant to Public Health Law Section 4201(3);
2. The surviving spouse;
2a. The surviving domestic partner;
3. Any surviving child eighteen years of age or older;
4. A surviving parent;
5. A surviving sibling eighteen years of age or older;
6. A lawfully appointed guardian;
7. Any person(s)eighteen years of age or older entitled to share in the estate and who is/are closest in relationship to the deceased;
8. A duly appointed fiduciary of the estate;
9. A close friend or relative who has executed a written statement pursuant to Public Health Law Section 4201(7);
10. A chief fiscal officer of a county or a public administrator appointed pursuant to the Surrogate's Court Procedure Act;
10a er person who is acting on behalf of the deceased and who has executed a written statement pursuant to Public Health
Law Sec n 4201(7).
(Initial ALL THREE the following)
%� Mle here y affirm that the body of the deceased does not contain a battery, battery pack, power cell, radioactive implant,
or radioactive devic and that any such materials were removed prior to the execution of this Authorization Form. Failure to remove
se ite for cremation may result in harm to the crematory and crematory personnel.
�� MM Cassidy VonStettina
I/We affi that instructions have been given to Y
(Funeral Drector Name)
regarding the rem al of any personal property or other thing of value which any person signing below or any family member of the
de wishes to preserve. Pine View Crematorium
(crematory Name)
is n ons a for the removal of personal items from the container or from the remains of the deceased. Personal items left in the
be destroyed b the cremation process and cannot be retrieved after cremation. I
container the remains will y y
Ilwe ereby authorize Pine View Crematorium
(Crematory Na—)
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to cremate t remains of the deceased.
FINAL DISPOSITION
The person authorized to receive the cremated remains of the deceased from the crematory is:
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Name: Regan Denny Stafford Funeral Home, Cassidy VonStettina
Address: 53 Quaker Road, Queensbury, NY 12804 Phone: (518) 792-1114
The cremated remains of deceased will be disposed of as follows:
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Return to family
If for any reason the person named above does not take possession of the cremated remains,
Pine View Crematorium is authorized to give possession of
(Crematoy Name)
the remains to Regan Denny Stafford Funeral Home b delivery
rY �
(Funeral Home Name)
in person or by registered mail.
Christian Patrick Mahar
(Name of Deceased)
DOS-1898-f(Rev. 08/15) Page 2 of 3
• A :I/We
' n for Cremation and Disposition
(Initial tfollowing)
un erstand that if the remains are not claimed within 120 days of cremation,
Pine View Crematorium may dispose of the remains in
(Name of crematay)
irretrmanner, such as by scattering.
CREMATION CONTAINER/URN
(Initial ONE of the following)
An urn to be used as a container for the cremated remains has been purchased from
9,ugt�poraroy'
ollows:
if the urn is too small to hold the entire cremated remains, an additional rigid container may be used for delivery.
-OR- not yet purchased. I/We understand that if no urn is purchased or otherwise provided
Pine View Crematorium will place the cremated remains in
(Name of Cramatory)
tainer for delivery.
This Authorization Form was provided by Cassidy VonStettina was executed at
(Funeral Director Na"*)
Regan Denny Stafford Funeral Home
(Funeral Home Name)
53 Quaker Road, Queensbury, NY 12804
(Funeral Home Address)
and is signed by the funeral director as witness to its execution.
IMe have received a completed copy of this Authorization Form.
The person(s) identified below is/are the person(s)in control of disposition,who by signing this Authorization Form,attests)
to the accuracy and completeness of the information contained in this Authorization Form and authorize(s)the foregoing.
Signed this 9th day of July yp
6'A '
Typed or Printed Name
Address
Vacli6on Mall
Typed or Printed Nan?e i � tore
2. 19(3 m � �� 5
Address
Typed or Printed Name igna
2 Pn i ll ipS A2, Qbi MY 12,E
Address
WITNESS: j
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Cassidy VonStettina
(Funeral Director Typed or Printed Name) (Funeral Director Signature)
13709
(Registration Number)
Christian Patrick Mahar
(Name of Deceased)
DOS-1898-f(Rev. 08/15) Page 3 of 3