Huertas, Maria E. ,rlZ�
Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME:Jv1 , RETURN TIME:
DATE & TIME REMAINS ARRIVED AT CREMATORY: S`S ZD
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
NAME•, CASE #
TYPE OF CONTAINER: ��
tj
PLACE OF DEATH ` z 1,00491 too
C l aa. )
ESTIMATED WEIGHT OF REMAINS & CONTAINER l
PLACED IN HOLD: /0•�� �h
PLACED IN REFRIGERATION:
DATE OF CREMATION: S - s- ZO Zv
TIME STARTED: �DS'��-, TIME COMPLETED: 51 Q 7n
PLACED IN RETORT: -Q 5-pf-n MOVED: 4133
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.
rats teem Of--43ft
Authorization for Cmmatian and DOP05 10n
"Mn.rry 1=1
(518)47
xwx.dos.3r�li.N/.�
Thb Auex r�zaftn Foray a<ruo b*con and i tad of remanm s f w CPirT1A�1cm
- Number
5 to
Date: Apn1l30.202fl
Cr+ematoryNsme: Pine View Crrrnat
Addrdss: 21 Road,t ueensburs'„NY�12804 . MOM:__518)_7j5-4476 _
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremation is carried out by placing the remains of the deceased and the container holding tie remains into at
cremation chamber w#tem that'are su*ded to interese:heat and Hartle_The head annl t3amo will incinerate and
consume ever/eft bons and rnstal,which we all that wM be Ifft a W cn+arnat9on.
Folkwing crems6on, the crematory will take reasonable efforts to remove all of the remains and other material from
the crrw ation chamber,but some mwwnW dust and resKko wig lik*be left behind. The crematory will separate
rw dertai rind foreign material film the renums arnd!till WKx%rdal and feign material will be diisposed of as
togL vd by law.The crernioted remains wilt be mechanically ptNWMW into small pastes and plooed into a
designate container or urn,Cremated remains 9"raly are puutvarinad until no single$ailment is
rocs ganisabie as skeieW basue_
�1t�G OF Ct1flT"1r�1HER
The crematory may only open the containerr holding the cur-cremated human remains as limited circurnstamc er., such
as to confirm the identity of the deceased or to ensure that no material is endosed whkh rri ght injure employees or
damage crerriaatwy property.if human remains am delivered in a container which is net sable for cremation
saach as a Ceremonial or rnnrtail casket the cromaWy wit require that the nrmins be moved into a suitable
comu*wr befogs It accepts the renrtaiam The opening of a torte in r or the transfer or renwval of remains will be
conducted betom a witness and will be done in pfevaoy,with dignity and respell.
LQUWFiGATIt]N UE QEGEASED
Name of Deoeased: Maria F Htwrtas Marita3 Status: Divorced
Last Knovrn Address. 108.26 bard Avenue. Forest Hills.NY 11375
Place of Death; Maimonides.edica]t..enter,4802 10th Aventae,Broak1m N1 'Y t l.22Pkl
Sex. ❑M OF Age: 85 DOB-_ 1?.17f 193.4 Date of Death:_4t-1 2020 Estimated Weight: fib'•
Description of caskeft ntoner in which ramams will be de iverecL
Wood c rcfixm d crremation Container 4. Star f"uncral Supply)
PARSON IN CONTROL Of QI5P92I1 QN
(Aw=(s)w tar AM of ow sftn.OW ONE of that folltowuV)
I amf We are the designated agent of the deceased designated in a will or written instrument executed
pursuant to PFubiiic Health Law section 4201.
-OR
Wft have no knowledge that the deceased executed a written iristrurreent pursuant to Public Neatfh Law
sedion+4201 or ar will containing directions for the disposiWn of his of her rerseam and (co*,xisanerr Pop)
Maria E Ifuertes
wroanJ[4{limn. Jwwm d _ psae-of 3
1 arnl yr are the Wson(s)hays WOnty under Public Health i_aW Section 4201 and ham the rigtlt to authorize
cremabon of the remains of the deceased 1!y!t)ur relaftrash;P to thl decombed is as follows;
M=W Aem ft W below)
"amber: ; description: _ .A[t]t s�trrirdrer
1.A Person des gnat@d in writing purscaant to Public Health Law section 4201(3);
2 Tile surviving spouse-,
2a.The surviving dorm partner
3.Any srr.rrviaing child eighteen years of age or oilier,
4~A surviving parent
5.A str►riving stbl-mg>ften years of age or older;
5.A WeAttlly appoko&d guardian;
7.Any petsor4s) W~]a=of or Okk r Wtided to stove in the estate and who islare closest in
relation to the deceased,
11-A duty appointed fiduciary of the elate;
9-A close Mend 4r relative who has e>occuted a wn ti~n startement pursuant to Public Health Law§4201(7);
10.A chief fiscal officer of a cotalty or a Pub adn*uj4auw appomted Juan to the Surrog e'S Court
Procedure Act
ipa Any ender person%+to is acting on behalf of the deceased and who has executed at wrMen statement
Pursuant to Public Health 1.8w§4201{7)
( ALL 7-PfR6E of the f yaw oo
rir4c3•, 11Ws hereby affirm ttW the beefy of the demised does not contain a battery,battery Pack, power call,
tDdQgcbw wnPI&M or radioactive device and that any such materials were removed prior to the execration of this
Author adian Form_Fadure to rernovo#rase iEerris prior to cremation may resort in harm to the crematory ww
crema"pers,cn nell.
"v INVe hereby affirm that nzstrucdions have been given to �+�e1 _ Steen_Duce
regarding the rernovai of any personal pn*erty or other thing of value whir any person signing below or miy family
mealier of the deceased wishes to preserve. t�View Crematory _ _a not
mWtW*for rearrcval of p6mr%aa ibe its from the der or from the remains of the deceased. P'OMWWJ items
Mrit in the corttsiner or with Ow renaaine vdN be destroyed by the,cr+ritiation pros and carnnat be retrieved
attar cnunatiion,
@ '"VVWO how* ►afthmm€ r noa Pine View C=nvtory to cremate the
ra adne of the deceased.
F'N&t]1lSP 0611it N
The person authormed to reomm the crarrrated retnam of the deceased from the crematory is-
Nanre: Fox Funeral Home,lnc.
Address: 9"7 Ascan A%,,cnuc,Forest Hills.NY Y t375 Phone- 71$) 5ii-771 l
The cxerrrated remains of deceased wi l be disposed of as follows:
Yet to be determined
—
If for any reason the person named above does not take posession of the crerrrated remains,
(o.mrMwy nrmr) Pine Vicew t'rematx ry —, is authorised to give Possession of the remains to
Mnordi t4ow 4&1*_ Fox Funeral Hwnc,Inc- � by delivery in pamon or by registered ma4.
Maria E fiuertas
tm6.10844 Mw.41I10) AWm or t5 8 for 3
-; Me uraierstand that d the ram am not ckkned withm 120 days of cremation,
fa�awftt Pine V iCW C'Mrriac Or% may dispose of the remains in an rreir-evabler rnamw,
such as by scattering.
22MItATKIHit C4NTiI1N+1„ ENURN
Of the+ *v)
An um to be used as a contairm for the cremated remains has been purcbaised from
_-,Fox Funcrsl Home,Inc_ and is described as follows:
UV%understand tot if the urn is too small to bolo tha entire cremated remains,an adMonail rigid container may be
usr;cl for delivery.
.OR-
_ PnO' An um has not yet been purc�, UY%understand that if no urn is purdiased or otherwise provided
RMOMMI Y ra ) ,.. fine View Cle_.rnator v wiil pWce the cremated remains in a rigid temporary
ctxrtirer for delivery
The Auftweabon Form was provided by ma+ wares r w*) Strvcn Duca
was executed at(wmww►some name) Fctx Funeral Home-Inc.
(rune air►,cane addrem) 98-07 As=Avenue,Forest f iit(s ,
as witness to irts exeaubm. _
NY t 1�7� and is signed by the funeral d>rr�ctor
IN*have received a completed copy of this Authorization Farm.
The person(s)identified balaw isf m the parson(s)In control of dfspos€kxi,who by signing this
Autfnwbxfion FOM,allgggs)to*0 accuracy and cornpieteness of the inforrnation contained in this
AuR#rortamion Form W d authorbae(s)!trio fbregving.
$ignood this day of April 20 , 0 .
7MZ Boulevard Ewa,Gu enbcrg„_NJ 07093 �
Aar.
Aftew
Addiew
Steven Ihua
Furj&W Dw ceor Typed w Pntopd Nam F4wz'arecW$00ft"
14007
Regmwim
�MN1r0er
Maria F.Mucrtas
DMIPJ -t(Rmr otltrl) ftAmw cfr d Faye 3 d 3