Lohse, Reinhard Peter Pine View Cemetery & Crematorium
Quaker Road C�Vl
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME:
REQUESTED RETURN TIME:
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
• � ' C
NAME:DATE OF CREMATION:
TIME STARTED: 1 `00/�
- --- -- --- -. In-- TIME COMPLETED:
TYPE OF CONTAINER: . [ laU
PLACED IN RETORT: �. /�
__.MOVED: .._. ��3S_ PI„
PLACE OF DEATH: .
ESTIMATED WEIGHT OF REMAINS AND CONTAINER:
DATE & TIME REMAINS ARRIVED AT CREMATORY: ZZ Zo to - 3 v'
_. ----
.................
PLACED IN HOLD: 1, !46
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.
0
P
pibry,NY
(618)47A
W�vw:das.state
enerrration.
4
f1Y 745=44i
errematns into a
"Mil incinerate an(
w �Wli r eiemat on.
° material fr(
lsparate
to YrnN be disposed of as
s F 1es arid.placed into a
M >G � a single fragment is
a $
a� f x
ns in.limited,circumstances, su
wttuhemightinjure employees
Bch is n sortable for cremath
remains be moved into a suitabh
y" orthe~==transfer or removal of remains will bE
gam ¢ d kad 'fi
Y Marital Status: Divorced
'.:11001
- ew H`de P2rk,1VY 11040
r Dade of,beath: 4/14/2020 Estimated Weight:o2_S7
x
r
of the'deceased designated in a witl or.written instrument executed
e 13xsdaanrrttteminstrument pursuant-to Public Health law
her remaths'and '(Conhrnued next page)
e
Reinhard Peter Lohse
x 7Vame 6ibeceased Page 1
t z.
F
•*1
^5b
F
k
3Y �.wade
a 4
<tealth E.aavH'§a201(7),
s
a E
ntt��siratement
fi
e ; battery Pack, power cell,
rto ex on of this
r
intiani >�o Me crematory and
.i• t
Steven Duce
n'sionino below,or any family
t :Pne, i rernatoryis not
emains of the`;tleceased. Personal items
cremation Process and cannot be retrieved
Y a r
a �
a to cremate the
f►`ort�tF1e crematory is
s
FAr remits to
stered
¢, -
u
Page 2 of 3
w'F
evable manner,
r?
F
" er. ay be
provided
.temporary
€. M a
t
-Ah6 funeral director
signing#his
,.:
o�ntart�ed"in this
pow
4�k
l�
Aw
.� Cf
} k
R'.+T-'t ice° �' '�- •sk
,. Rnhard Peter Lohse
Name of Deceased
Page 3 of