Loading...
Bierfreund, Eugene Pine View Ccilictely & Crerrmtoriulll Quaker Road Queensbury, NY 12804 ()18) 745-4477 or (518) 745-4476 Funeral Home 2JD�5 Requested Retul•n `I'iluc Naulc4­+-fey► ;er -------------Case No. ------ clg7- Date of Cremalion_1��99 hinlc started f 2oSy.n_"Time Conipleled_�>�pm Placed in I-Iokl: Placed in Refrigeration: Placed in Retort: Typc of Container Go ya +;tie/ .- ----------------------------------------------------------------------------- Remarks --------------------- Mails ----1 zi0 _ ------ Move-_I-3 2?1h.---------------- Place of Deatli- -_ ------�-_fI.Qg91 �`_�/z✓ ---- Estimated Weight of Remains and Container_ /So ------ SG��e----3p --'- ------- Date &"hlme Remains arrived at Crematory__'7- 2O 9m__________ Name of Funeral Director or Registered Resident. Delivering Rcnrains�lk/f� ��QS�vyl�jn G- Detailcd reason for delay if rcillanlS wCCc crematcd rllorC than 48 flours from time of accepted delivery --------------------------------------------------------- -------------------------------------------------------- Retort Number in which Rcmains were crcnmted___7_A a TA _ _ -0 Note:,riie Cremation Log shall be retained in tlic Pcrnia nciit Filc of the Crematory From:Red Cross 904 701 9236 07/29/2019 09:36 4139 P.003/013 , New York State NEW YORK Division at Department Of State STATE OF DIVISION OF CEMETERIES OPPORTUNITY Cemeteries One Commerce plaza 99 Washington Avenue Albany,NY 12231-0001 Telephone:(518)474-6226 Authorization for Cremation and Disposition www.cfos.ny.gov This Authorization Form must be completed and signed prior to delivery of remains for cremation. Date: 07/28/2019 —_— ---_ Number: Crematory Name: Pine View Crematorium Address. 21 Quaker Road, Queensbury, NY 12804 Phone: 51 EI 793-4'753 '— 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:_Eugene Bierfreund Marital status: Never Married Last Known Address:_4573 NY 40, Argyle, NY 12809 —� Place of Death: Glens Falls Hospital, 100 Park Street, Glens Fails, NY 12801 � Sex: ®M 0 F Age: 77 DOB- 09/11/1941 Date of Death: 07/20/2019 W Estimated Weight: 150 (bS Description of casket/container in which remains will be delivered. Buffalo Casket Company—Alt container PERSON IN CONTROL OF DISPOSITION (Person(s)in control of disposition,initial ONE of the following) 1 am/We are the designated agent of the deceased designated in a will or written instrument executed pursuant to Public Health Law Section 4201. -OR- I/We have no knowledge that the deceased executed a written Instrument pursuant to Public Health Law Section 4201 or a II con ing directions for the disposition of his or her remains and Iiwe are the person(s)having priority under Public Health Law Seeti 4201 and have the right to authorize cremation of the remains of the deceased. My/Our relationship to the deceased is as follows _ Eugene Bierfreund DOS-18984(Rev. 08/15) Page 1 of 3 From_Red Cross 904 791 9236 07/29)/2019 09.36 111139 P.1304/013 Authorization for Cremation and Disposition (insert from the list below) Number: 5 Description-Sibling 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. Any other person who is acting on behalf of the deceased and who has executed a written statement pursuant to Public Health Law Section 4201(7). X27; HREE of the following) 111Ne hereby affirm that the body of the deceased does not contain a battery,battery pack, power cell, radioactive implant, or radioactive device and that any such materials were removed prior to the execution of this Authorization Form, Failure to remove these items prior to cremation may result in harm to the crematory and crematory personnel. IIWe affirm that instructions have been given to Mark J. DeSimone ---- regarding the removal of any personal property or other thing of value which any person signing below or any family member of the deceased wishes to preserve. Pine View Crematorium (Cie-0y Weme) — —is not responsible for the removal of personal items from the container or from the remains of the deceas(-d. !Persona)items left in the container or with the remains will be destroyed by the cremation process and cannot be retrieved after cremation. I/We hereby authorize Pine View Crematorium fclw-ay Nary) ---- to cremate the remains of the deceased. FINAL DISPOSITION The person authorized to receive the cremated remains of the deceased from the crematory is: Name:Emil Bierfreund Address: 1120 Bellemead Blvd Jacksonville Florida 32211 Phone (904)721-2211 The cremated remains of deceased will be disposed of as follows: Return to the family for burial in Somers, NY 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 (C—Mit ry Weme)the remains to Regan Denny Stafford Funeral Home by delivery (r-~*1Ham Nerve) in person or by registered mail. Eugene Bierfreund �.+-- (Kamp or Oeo"wd) DOS-1898-f(Rev.08/15) Page 2 of 3 From_Red Cross 004 791 9236 07/211/2019 09-37 a130 P_005/013 Authorization for Cremation and Disposition (lniti l following) I/We understand that if the remains are not claimed within 120 days of cremation, Pine View Crematorium rya Diu ----_—_— _—may dispose of the remains in an irretrievable manner,such as by scattering CREMATION CONTAINERIURN (Initial ONE of the following) An urn to be used as a container for the cremated remains has been purchased from Regan Denny Stafford F1.117L1t[.^dt�IPnAa -., and is described as follows: -- I/We understand that if the urn is too small to hold the entire cremated remains,an additional rigid container may be used for delivery.L -OR- >� 4An urn is not et y purchased. IJWe understand that if no urn is purchased or otherwise provided Pine View Crematorium (Nww of lwyj __ will place the cremated remains in a ngid temporary container for delivery. This Authorization Form was provided by Mark J. DeSimone -- —_was executed at —(Fu,awOrn:k+Name) Regan Denny Stafford Funeral Home (Funeralliane Name) —� 53 Quaker Road, Queensbury, NY 12804 (Funeral F+onk -------- and is signed by the funeral director as witness to its execution. I/We have received a completed copy of this Authorization Form The person(s)Identified below islare the person(s)in control of disposition,who by signing this Authorization Form,attest(s) to the accuracy and completeness of the information contained in this Authorization Form and authorizes)the foregoing. Signed this 28th day of July ,20 1 / Emit BierAlone ryyae Or Rmted Hems -�g,,,"h�ae�-�/ 1120 Bellemead Blvd, Jacksonville, FL 32211- arteaa — --- ,p-d a Prow Alone �al„� --------- ------ Typed or Rb ftd Nome Sgnatwe.—�. -- ----- Aaa/eaa WITNESS: Mark J. DeSimone (Funere!Oaecb Types or PmW Hemel `---"-------------- - 10919 ( ceff- Eugene Bierfreund (Name of ofOrcolsedj DOS-1898-f(Rev,08115) Page 3 of 3