DeSanto,Rita Marie Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME:
REQUESTED RETURN TIME: T}I+IRlQ
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
C 5YA go+-Em
NAME: CASE # S�
DATE OF CREMATION: ��l$
TIME STARTED: TIME COMPLETED: Z Y
TYPE OF CONTAINER: _ 16AA4(4((u`�' C�fk Lw u�4- y wdd(� _
PLACED IN RETORT: P1 I MOVED:
PLACE OF DEATH: S�ra�ac5 ��ecPMAII
ESTIMATED WEIGHT OF REMAINS AND CONTAINER: /y0 1�6
DATE & TIME REMAINS ARRIVED AT CREMATORY: ZbSI to Q-%b Qh
PLACED IN HOLD: W30
PLACED IN REFRIGERATION:
RETORT # IN WHICH REMAINS WERE CREMATED:
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
NYS Departrnent of Scx«
Authorization for Cremation and Disposition Division of;,trmetcnes
Jnc(:un,�nnrce Piaz:,.99 Washington Avenuo.
Alhany.NY 12231
(518)410-62m
.vvvew dos.stato.ny.us
This Authorization Form must be completed and signed prior to delivery of remains for cremation.
Date 02/13/2020 Number: 151
Crematory Name: Pine View Crematory
Address: 21 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 wii!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 rnechanically 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 jQCiiNLAINER
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 crematory property. If human remains are delivered in a container which is not suitable for cremation
such as a 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 Rita Marie DeSanto Marital Status: Divorced
Last Known Address: Homeless
Place of Death: Saratoga Hospital
Sex: UM XF Age 69 DOB: 04/12/1950 Date of Death: 02/11/2020 Fstirnated Weight:
Description of caskellcontainer in •.uhich remains will be delivered:
Connecticut Casket Cremation Container w/wooden base
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
0 -
UWe have no knowledge that the deceased executed<. written instrument pursuant to Public Health Law
o 4201 or a will containing directions for the disposition of his or her remains and (Contimmd M'xrpagt)
Rita Marie DeSanto
COS-1898-r-1 iRi• D i,ll�t Namr e;D,•,rea sen I'.ige 1 nl 3
I am/we are the person(s) having priority under Public Health Law section 4201 and have the right to authorize
cremation of the, remains of the deceased. My/Our relationship to the deceased is as follows:
(Insert from the list below)
Number: 3 Description: Daemian Passarelli (Son)
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§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§4201(7).
( f i ALL THRFF of the following)
I/We hereby affirm that the body of the deceased does not contain a battery, battery pack, power cell,
active implant, or radioactive device and that any such rrratenals were removed prior to the execution of this
RAuth,r,,ation
Form. Failure to remove these items prior to cremation may result in harm to the crematory and
e atory personnel.
_IIW- hereby affirm that instructions have been given to (Amerafairectorname; Rolland G. Hoag
_ ---
V,m
ding the removal of any personal property or other thing of value which any person signing below or any family
ber of the deceased wishes to preserve. race,Hnry n17,,:ej Pine View Crematory is not
responsible for removal of personal items from the container or from the remains of the deceased. Personal items
lef 'n the container or with the remains will be destroyed by the cremation process and cannot be retrieved
ter remation.
-_11We herebyauthorize c,,,n,,,trx ,: ,,,,•, Pine View Crematory
i r --- -- - -__ _ - __ ----- ------to cremate the
ins of the deceased.
FINAL DISPOSITION
The person authorized to receive the:cremated remains of the deceased from the crematory is:
Name: Compassionate Funeral Care,lnc.
Address: 402 Maple Ave., Saratoga Springs, NY 12866 Phone: (518) 584-4844
The aerated remains of deceased will be disposed of as follows
Return To Family
If for any reason the person named above does not take possession of the cremated remains,
rr ,nato� -,,.,,„..; Pine View Crematory} _- _-_ rY _ _ is authorized to give possession of the remains to
Compassionate Funeral Care, Inc. by delivery in person or by registered mail.
Rita Marie DeSanto
DO I$98-f 1 tRov (}lil(h N.;me of Dow'jsnd _ Pago 2 of 3
i
(nitia- he following)
_I/We understand that if the remains are not claimed within 120 days of cremation,
rer n,y ndrne) Pine View Crematory,_,_-_ may dispose of the remains in an irretrievable manner,
as by scattering.
CREMATION CONTAINERIURN-
lnitial ONE of the following)
An urn to be used as a container for the cremated remains has been purchased from
--------_ -_- __ -_ _-- �_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.
OR
An urn has not yet been purchased. I/We understand that if no urn is purchased or otherwise provided
(r.ren,atoryname) Pine View,Crematory, _ _ will place the cremated remains in a rigid temporary
container for delivery.
This Authorization Form was provided by trunarat director narno Rolland G. Hoa
was executed at (runBrai home rrarne) Compassionate Funeral Care., Inc
(tunerat home address)____ 402 Maple.Ave Saratoga Spnn-gs. NY 12866 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 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 - 13th - --day of February n��
,20_20
Daemian Passarelli
Typed w Pnnfed Name rgnature
2411 26th Street, Queens, NY 11102
hddrPSs
l yped nr Printed Narne
hd drr:>s
typed or Printed Name Signature —
Address --- --
WITNESS: /
_ Rolland G. HoagCam`' I-IC5 C�-
Funeral Uhector Typed or Printed Name_-- ,1i' f urruai Director Signature
11636 _
Registration Number
Rita Marie DeSanto
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