Minuche, Arruro A. Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: ky�e/ �,r�► RETURN TIME:
DATE & TIME REMAINS ARRIVED AT CREMATORY: 's- 6-202C) 33oar•
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
NAME: _J`T r `CJ I1,n Iit e�h Q CASE # �S �
TYPE OF CONTAINER: 1Q.vt ct3 yr' ,`,, Q✓
PLACE OF DEATH: k/ e I P/ T/Dsj, b e,�- F ,n cek<up-
ESTIMATED WEIGHT OF REMAINS & CONTAINER
PLACED IN HOLD: 3110 �M
PLACED IN REFRIGERATION:
DATE OF CREMATION: S h I ZO �q
TIME STARTED: 7 �fOFiTi TIME COMPLETED:
PLACED IN RETORT: TTQ/ 1I1 MOVED:
RETORT # IN WHICH REMAINS WERE CREMATED: SLygL Uc f4y
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.
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Deportment of$bite
CE? NEWYORK Di�isi�r� of DIVISION OF CEMETERIES
STATE OF �n�l�S7mrtl�rrq l+l:±to
_ OPPORTUNITY. �Gl�lt't�'rl@S v9 wwwrgion Av nwt
INAOW Albany.NY 12231-0901
Telephone:(510)474.6226
Authorization for Cremation and Disposition
This Authorization Form must be completed and signed prior to delivery of remains for cremation.
Date:4/27/2020 Number: --
Crematory Name: ��
� Phone:
Address:
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 u Cremated remains generally are pulverized until no
m.
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:Arturo A MinuChe Marital Status: Married
Last Known Address:2022 Bogart Avenue Bronx New York 10462
dace of Death:Weiler Hospital Of Albert Einstein College Division
Sex: ®M ❑F Age:83 DOB:2/6/1937 Date of Death:4/23/2020 Estimated weight:
Description of casketicontainer in which remains will be delivered.
wooden container
PERSON IN CONTROL OF DISPOSITION
person(s)in control of disposition,inthal 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.
-OR-
1 7 IIWe have no knowledge that the deceased executed a written instrument pursuant to Public Health Law Section 4201 or a
will containin are the
s)having priority under
Section 42019 directions nd ha a the right to aauthorizetion f his or her remains and cremation of the remains o the deceased.n( Public
My/Our relatio sh p to the deceased is as
follows:
ArtU Arturo Minuche
Schuyler Hill Funeral Home
TR050120_FH06/C09/042
DOS-18984(Rev.08/1 a)
Authorization for Cremation and Disposition
(Insert from the list below)
Number:2 Description: Wife
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 islare 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;
103. 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).
(/tliLL 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.
r" I/We affirm that instructions have been given to Jeannine Carbone
(Funeral D?Maaf 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. t' �. \� f f" a� a+r
(C-OWNr Name)
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.
a
I/We hereby authorize
(Crematory Name
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 _ w
The cremated remains of deceased will be disposed of as follows:
return to family from Schuyler Hill
If for any reason the person�nameed�above does nottake possession of the cremated remains.
.\G C-q— is authorized to give possession of
(CMrraiery Name)
the remains to Schuyler Hill Funeral Home by delivery
(Funeral Hama Name)
in person or by registered mail. Arturo Minuche
Artul Schuyler Hill Funeral Home
TR050120 FH06/C09/042
DOS-1898-f(Rev.08/15)
Authorization for Cremation and Disposition
(,niti the following))
IlWe understand that if the remains are not claimed within 120 days of cremation,
sa
may dispose of the remains in
(NW M of cMmatory)
an irretrievable manner,such as by scattering.
CREM TION CONTAINER/URN
(►nitia ONE of the hollowing)
An um to be used as a container for the cremated remains has been purchased from
and is described as follows: - _ �_ rs_.,a, _._m_- ,w•
Uwe understand that if the um is too small to hold the entire cremated remains,an additional rigid container may be used for delivery.
-OR-
An um is not yet purchased. UWe understand that if no um is purchased or otherwise provided
i(11VJ (,J CAI O _- r � will place the cremated remains in
(M M of womafow> -
a rigid temporary container for delivery.
This Authorization Form was provided by Jeannine Carbone �-was executed at
(Funer+t DNecror Name)- ----
Schuyler Hill Funeral HomeO�M --
rw H_NWN)
3535 East Tremont Avenue, Bronx, New York 10465_m_ _ - -Hamu- �— -
(Fwand Ha Ad*"S)
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 uthorization Form,attests)
to the accuracy nd completeness of a information contained in this Authorization Form and a orize(s)the foregoing.
Signed this � day of �Z
e
Italia Minuche
t_.
rypW orP�tnted Memo 0, XA_
,y
2022 Bogart Avenue, Bronx, New York 10462 --
Addmae
TypWorprYdedNeme
Address
Typed orPMOW Name Stgaehas
Address
WITNESS:
Jeannine Carbone ,,, . ,
(Pma W Dftdo►T y W or Prir#ed M—)
10534
AM Arturo Minuche
Schuyler Hill Funeral Home
TR050120_FH06/C09/042
DOS-1898-f(Rev.08/15)