Hitchcock, Jr.Harold Arthur .New war�:
RAW PORK DivisionOt Dlmeo STATE OF a"Cnr.:Mv..R...
Cemeteries d
♦rg0dnAISlal4aNalla
Authorization for Cremation and Disposition
This AN d, ,,Farm muss M comploW arm Mimes prior to tlNirary Wm elm for construction.
Dale: DsrzlrzozD Number. G72
cremabry Nams: PIIIe View CMMatary
Aaarw: 21 puakef Rd., Quee Wq NY 128M Prom:
CREM MN IS AN IRREVERSIBLE AND RI PROCESS.
Cmmahw is comM wl by plating the remains&Me Eve and the Unitlrer hollrq Ma mraim into a uemabn WmEw v m
May are attended W intense seat and Memo. 1M less form Mma we Inelllerab and c m use avxyWng except Sena and melel,
match am all Mal will be eX after mmseen.
Foramina uemalioM1 the crematory will fake resacal All rwmve at of Me h m me,and other malenel from Me annual
odamtec but some minimal dust also .Maude¢fall fee" left refund. lie cremaory will Word*mora ltl and foreign maenal tram
Me remains and Ilse Nridenlal and foreign matenal will be dispmd Nan ranuned by law. 1Te mmatotl rareins sell Ce mecnaoa:ally
pubensM Into small yams antl pleIXtlinbadesignatM mMaweeIXum. CremaW mnaim genemlly ale pulveri until no
all eagmw Is rxagniute as skelXi"Sue,
OPENING OF THE WWAINER
me mmatwy may only often Had consumer noway An umcremred human rea m limied awmmarces such as A eonfiml the
ksnNy of NO decreal or to ensure that no Manuel Amended shim M19Mlnure amploym or damage lM cmrebry pmreny. if
human remains are delivered in A container which is not mirmi For cremation such as ceremonial for nM1 mktr the
creemanowe well All that Me remains as moved into a suitable coneimr reactor accepts Me remains. The awning of
coneimr or the transfer w removal N remains vnll As mnducud before A Adored and will be tlone in already.warm di and respect
OENIIFCATON OF Didilay O
Nauru of Deremf. Hands! Arthur Hitchcock, Jr. Mahal Slmw: Never Menietl
Lost Known Actress: 111 Madison Avenue Apt 9 Albany NY 12200
Pura DI Death Albany Metllcal Center, New Smuand Ave., Albany, NY iay]
Sum ®e OF Aga: 79 Doe. 0412011941 Dme mM: M21N2020 Eathmsed wagM, 1W
Ceauipdon a ua =Mmmr an wakes form Art be dNrvwed.
New England Cremation Metal container
CONTROLIFERSON IN OFOSMSI9I
(Persm(S)in canfml ofdkpe Mt CNE of Ma MWwirIM
I amMd are the tlm91ImM aaam 0 the dereamd magnu M a far or wrilMnimmmat ua sense Is Iii
HUM lam Sgion 4201.
i
% 4k4 IlWetuve no knowledge Mat the decrease Manuel a wnMnmemoull purmoul Public Health Law SMw 420101a
wit mile deeamm far the disposal of his or me remains and Ifwe are Me rental aderne; areas Mae Pudo Heats Law
Factor 4201 and have the dim to auMmitt cre Low of Me remain,mthe deceased. YylOurremtiemhiptetheUaasedmas
blows:
HerDM ANmr HifcM1Wck, Jr.
0�-18BSi(Pm. WI20) Pee I M 3
Authorization for Cremation and Disposition
n,..d Hain fie Nt peal
Numq= 5 DetmpaOn;Surviving Sibling
1. A pertm aesgnTea in wmea purst In Puhl'e Hearn Law SMon wvh(3).
3. The eurnvxlp spmse,
L. The survang arrtealic partner;
3. Any slxvwvlg NOW essibi"am of age of Main.
t Aeurvrcrg parent
S. AWMWng wdnp eg hben years of any or okn'.
6. AIsmi lly appainba gwM,an
T. AM param(e)egM nyears Meg,a,01e fixed In shred in Me estate and who Ware cosset l n rely ShV to Me demsar,
0. A duty appointed fidutlary M Me e9late;
0. A caefiiend or relative who kaserewM a wdtlen 9Memenl punuanl to Fat Health Law Section 4201(7);
10. Achef Rtal oHcx of a county a,a pudic etransaction aMonl pursuant b the Sumgate L Chun Pmcedure Apt
real My Other person whi aping on behalf of Me aereesM and who has exe=Weaa Winner slelement partners to Public Health
Law SeGon 421
rin=el ALL THREE V Me ldbvnrq)
K CA 4�( We hereby affirm that me h or 0w sew adds na=mWna ENery. pinery Wok, power call raaiowl imgam,
or raaiasclire ae+ie ,and that my such melanek were nmo Wor to Me eeewaon of arm AWh afta form ferule to remove
Mueibm purr to cremation may muh i n M in,tope cn q and cremeWry pemmnol.
X 6Cq ln'ue affirm Maintenance;have been given m David Alexander
reporting the rei Y any personal ga or Other Nirq a adus whh any p agning We,or any family member W the
dereased winree to humerve. Pine View Crematory
Mandarin
is nolresmnsiak for Me removal all%rsom Oems Had tM¢ndner orfrcm the remains of Me dtteasM. P nelibms MXinthe
=amain..w x1NMe,singing boll a aeetmy.a q ma=remewn pm=®e arm canna m mrlwea amr cremNion.
X 44 awe Mn aWhwm Pine View Cremalgry
i"mruv to cmmlelM remains of that G eon",
11r=a1(MT10NAL)
lM hereg aNhortae me named funeral die r to pmviaeb dlivery bead Ime eon by an all
covermstril if acorn MI mommary In the opinion of the bneral dims r,and to amana MM form to pmviae thi an nametine
addrew M such allemam cremXory.
FINAL DISPOSITION
The person aulhoriuy b racnve the cremabd remains a11M hOvtea hard Me pemeMry is:
Name-Alexander-Baker Funeral Home. David Alexander
Amress' W09 Mein Street Wanenaburg, NY 12US Phone: (510) 623Z)65
The tte «mans Naem all be disposed M as leave:
Realm to family
Nbr any mawntlre Wmn tamed above dean not take pmseadon of 0q lmreled roman&
Pine View Crematory, wan ,w to give mat ion of
eastern saw,
yy mwlnyb Alexander-BakN Fummi ibme galiwry
In person or by Mgt tree. Harold Uf HIfCltcock. Jr.
CONS 1Ng f1Rev. Nol Page 2 of
Authorization for Cremation and Disposition
r!ci me doods")
i
n�a.19 leas understand Narxthe remains are na nsm AwNhin t20 myf Mcrelrwrun.
Piney Ctmnatary mw dispmae Of be homeless,
an handsome tamer.Llfb as byeuMnrg_ mum✓mew
RNRR
(I ONE of may«mwmm Alexander-Baker Funeral
An um to to used as a Neater for she crema4U female halt been mechaxO from
and is dwmfbed as filki
Ime uMentaM Mn dsell um labs small Is hold the wall oeme amens, an sections rad Whe firer my had uaedbr derMy.
-oR-
x dQ M um a not yet 9urchaxd. lmine u Undreamed Nm th se she a wrCl®et or elemental Frei
Pine v C will price the aama m IM in
a dill comments consumer he derwery. �� a
The;Assortment Form was provided by Dial AMomennt was exxNM or
Alexander-Baker Furseral Home
3009 Main Stret.7ane61bur9. NY 12a05 _
and is WW by Me Nnalal director as siNeas to he moulder w•w
them have rpslvM a completed copy of this AUNonxa re,Form.
The gnonio Identified btw Wen me prommerl in commit of summertime,who by si0nm9 mb AUNonxabon Form.;wvwdm
b the ecmunry are embitterment Mdw information collated In MisAWrorizNon Form and eW romobst the foraming.
alyrwd Mb 21n daymf May .m 20
Donna Fay FJlbr '� 1 �h
3122 Upper Orne, lake Oawe9o, OR 97035 —
Will
David Alexander
or t0034 sine>�
Herod Amm r Hitchcock. Jr.
Rpa 3
Pine View Cemetery a Crematorium
Quaker Road
Queensbury, NY 12864
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: ___-ftftq Kc_._- - --„--_ RETURN TIME:
DATE A TIME REMAINS ARRIVED AT CREMATORY'
- —Sf_ERIN G --MAINS,
NAME OF FUNERAL DIRECTOR OR REGRI$TFREO RESIDENT DELIVERING REMAINS,
NAME: -N� _ LiCILCOCK._ . Sk /
-- - CASE IF
TYPE OF CONTAINER: - NV R
--- AdPrt _ 1 r—
PLACE OF DEPTH;
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER-
PLACED IN HOLD:
PLACED IN REFRIGERATION: -- ry � ---"-"
Y"ro__ _
DATE OF CREMATION: �—"-'---
TIME STARTED:
-- �---.__TIME COMPLETED:
PLACED IN RETORT: -'tDPpa." _
- ._—MOVED:RETORT A IN WHICH REMAINS WERE CREMATED: S. f
DETAILED REASON FOR DELAY IF REMAINS WERE LREMgTE E q HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTEr THE CREMATOR LOG SMALL OE RETAINER IN
THE PERMANENT FILE OF THE CREMATORY,