McCarthy, Greta Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: s(NU`(cC.R �L((. RETURN TIME:
DATE & TIME REMAINS ARRIVED AT CREMATORY: 5IH I 11`y0
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
N-(RA-q D04A A
NAME: Rfx MCCAKT 1 CASE # qls
TYPE OF CONTAINER: Waif..— ev,-,A4"r
PLACE OF DEATH: 3100 t vA
ESTIMATED WEIGHT OF REMAINS & CONTAINER 16o i
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: LJ ���' Zola
TIME STARTED: 7 dd,2, TIME COMPLETED:
PLACED IN RETORT: 9D�,yn MOVED: / U2�Dl-'Z
RETORT # IN WHICH REMAINS WERE CREMATED: �OLJQ� p4 h 'ter'
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.
New York State
'Department of State
--f�;NMYORK Division of DIVISION OF CEMETERIES
STATE OF One Commerce Plaza
OPPORTUNITY_ Cemeteries 99 Washington Avenue
Albany,NY 12231-OW
Telephone:(SIM 474-6226
www.cos.ny.gov
Authorization for Cremation and Disposition
This Authorization Form must be completed and signed prior to delivery of remains for cremation.
oate:4/30/2020 Number: 41$
Crematory Name:Pineview Crematory
Address:Queensbury, New York Phone: �I4 -hf- 4
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: Greta MCCarthy Marital Status: Married
Last Known Address:3900 Bailey Ave 11 M, Bronx, New York 10463
Place of Death: Deceased Residence
Sex: ❑ M 0 F Age:87 Doe:8/25/1932 Date of Death:4124/2020 Estimated Weight:
Description of casket/container in which remains will be delivered.
r-
wooden container r
PERSON IN CONTROL OF DISPOSITION
(Person(s)in control of disposition, 'n''s/ONE of the following)
I am[We are the desig nated agent of the deceased designated in a will or written instrument executed pursuant to Public
Health Law Section 4201.
-OR-
UWe have no knowledge that the deceased executed a written instrument pursuant to Public Health Law Section 4201 or a
will containing directions for the disposition of his or her remains and I/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. MylOur relationship to the deceased is as
follows:
Greta McCarthy
Schuyler Hill Funeral Home
DOS-1898-f(Rev.08/15) TR050120_FH06/C09/050
£'d OLLt-CZ"LL-1, _ __
Authorization for Cremation and Disposition
(Insert from the list below)
Number: 2 Description: husband
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,
S. A surviving sibling eighteen years of age or older,
6. A lawfully appointed guardian;
7. Any persons)eighteen years of age or older entitled to share in the estate and who is/are closest in relationship to the deceased;
B. 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 SurrogaWs Court Procedure Act
1 Oa. Any other person who is acting on behalf of the deceased and who has executed a written statement pursuant to Pubic Health
Law Section 4201(7).
(initial ALL THREE of the following)
i(We 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.
_INVe affirm that instructions have been given to Jeannine Carbone
(Furj*w ouedw Name)
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. Pineview Crematory
is not responsible for the removal of personal items from the container or from the remains of the deceased. Personal items left in the
container or with the remains will be destroyed by the cremation process and cannot be retrieved after cremation.
f-�A—Ilwe hereby authorize Pineview Crematory
(Cremarery Nome)
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:Schuyler Hill Funeral Home
Address: 3535 East Tremont Avenue Bronx New York 10465 Phone: 718-792-0270
The cremated remains of deceased will be disposed of as folows:
return to family from Schuyler Hill
If for any reason the person named above does not take possession of the cremated remains,
Pineview Cremator/ is authorized to give possession of
(c e-fty Name)
the remains to Schuyler Hill Funeral Home by delivery
(fumml rams Name)
in person or by registered mail. Greta McCarthy
Gr( Schuyler Hill Funeral Home
TR050120 FH06/CO9/050
DOS-1898-f(Rev.08115)
b-d OLLt?-£Z8-2LL-L P%illVr;--V
Authorization for Cremation and Disposition
(/ni ial the fntlowing)
J11We understand that if the remains are not claimed within 120 days of cremation.
Pineview Crematory may dispose of the remains in
(Hams of Gxnatlm
an irretrievable manner,such as by scattering.
CREMATION CONTAINERIURN
(lnifial ONE of the following)
An um to be used as a container for the cremated remains has been purchased from
and is described as follows:
IPWe understand that if the um is too small to hold the entire cremated remains,an additional rigid container may be used for delivery.
-�-JOR-
v , l —An um is not yet purchased. Uwe understand that if no um is purchased or otherwise provided
Pineview Crematory will place the cremated remains in
(Na"of c emawy)
a rigid temporary container for delivery.
This Authorization Form was provided by Jeannine Carbone was executed at
_Schuyler Hill Funeral Home (Funoat Dlreeb Na—)
(Funeral Home W mw)
3535 East Tremont Avenue Bronx New York 10465
(Funeral NOW Ad*aas)
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 Authorizathm Form,attest(s)
to the accura(cy� th
d completeness of the Information contained in this Auorization Form and au#w►ize(s)the foregoing.
Signed this D day of
James C McCarthy
Typed orPimad Name
3900 Bailey Ave 11 M, Bronx New York 104
Addreu —
TYGed or Po"ad alma Slgnatee
Ada}eu
Typed or PrWed Woe Synehme
Adaness
WITNESS:
Jeannine Carbone7L.Q�
(Funeral DmcW Typed or Printed Nome) (Funeral Diroetor
10534
{ 'u�moR Number
GI Greta McCarthy
Schuyler Hill Funeral Home
TR050120_FH06/CO9/050
DOS-1896-f(Rev.0805)
5'd OLLtr£Z8-8LL-1,