Canavan, Susanna Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME; 5 5 r_ RETURN TIME: 94FE
DATE & TIME REMAINS ARRIVED AT CREMATORY: VISI TD 1YAH
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
ossLDY UAL) Tr INA
NAME: SVSAAMA 6A10AIMP CASTviLES 71)
TYPE OF CONTAINER: RR�IIIIo.B- afryW & a4d
PLACE OF DEATH: � H IIL (/�d JL Ia( 1
ESTIMATED WEIGHT OF REMAINS & CONTAINER NIS IAr
PLACED IN HOLD: (D,D4 An
PLACED IN REFRIGERATION: y,
DATE OF CREMATION: IIl1Ito �
TIME STARTED: _ A �TIS AM TIME COMPLETION )L'�(
PLACED IN RETORT: to:R* An MOVED: ¢II'1V( A�'N/111
RETORT # IN WHICH REMAINSWERE CREMATED: Sim `• ft mk
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN " HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
sAWwRN Division of m"`"�
STATEaf ` aN NOFC METP M
OPPORIUHRY. Cemeteries Am Washington Avenue
l 1221
ielron wow Cwa22a
nvm+
Authorlmition for Cremation and Disposition
"is AutlpXFRbr Ferns nml toe compared and signed prlor by eeIMry aromans for mountain.
tarn.
Oak: OB/OBI2020 Numec 7 �
comment Name:Pine Yaw Cralnatodum
Addrse:51 Quaker Road, Queanabury, hill Plane: (518) ]45-44]]
CRENN1 IB AN IRREVERSIBLE AND I'lli PROCESS.
Cramel a mmetl old by Normal Me remalM d Metleceeset And Me cadaimr Folding the remains into a v Mon Wmesr washe
May are sudetled A intense Lear and here. The had and toms will mdneM and commie everything except Lone and mNe1.
whkh ere at l that wil l toe left after assurance.
Fdlumne chromium.Me crematory wlll take reasomde all to remove all ofMe remains ant Goer materiel Than the uemal
chamber, but mom2 minimal dust and residue will likely he leg behind The Gemtlory will separate incidental and breyn mal from
the remains and the Inoeental and foreign mahnal all the unsecured Area real by W'. The cemakd remains will the material
pulvenzee into small press also pMttdInto a Automate] xnlsnacrum. Cam remains presidential pulwrlxq until As
*into fragment is eceeniaable as skaNal asses.
OPENING OF THE CONTAINER
The comment may only open Oe container heading the unuemeMd human measures in limited dramaanma,such as to confirm the
Identiry&the de¢ nice ensure Me no Aatenisl 'A endoed which might inlure employees or damage"vematory pmperty. a
human remains are delivered In a container whim Is n&surableror camel such as communist or ante easkq,ore
cmnakry will require met Me be moved Into a vufti te mr n ai orders Nacm Mpe de remains. T opening o amaimr or neaamrer or remorel&eakns will x maeemee Before a wimess ens mall m tens is pdvery, adM egrvry sad respea.
IDENTIFICATION OF DECEASED
NamedoemawM: Susanna Canavan slerilal smha; Widawr;tl
Urn shown Addeme.,21 Pinewood Ave. Queensbury, NY 12804
PNm ArDwd,Wesley Health Care Center, Lawrence Street, Saratoga Springs, NY 12M
Su: Dal Iq: 83 DOB'. 0 UDW193fi DSN aCwM: O M712020 EamaeNd
Deunpeon of c�uYWVU ��n�e M which sma�rm se
ll brdervneedd lyyy p1�_ 1
1 \ -Y-+,TII�pA+)S— L�C'C4 C(tJ.Q1.Ue \II
PEASON IN COMM OF DISPOSITION
(Formal so codM assessment, di ONE atMldbxinp)
small are the composted agent of Me eeweoe desgrmled in a sill or woman ineWneM WMBd moment W Public
tbYM Use seamen 4201.
-OR-
LWe have no knowMbdge that the dexnetl emc&ed a wriven neuument powder b Pudic Hanson Law Section 4201 ua
mrdMni p dre lines for Me th posteen ofbi or her amens and love are the awards)having pro icy under Publl<HGM taw
Saalcn 4201 and MVB the night m auMonm uamaom 01M remalru Nthe decal station crescent to may decuvad k e
fti x
Susanna Canavan
COS-tagbt dif Mullin PaOe 1 &
Authorization for Cremation and Disposition
fMSMfmmfelig taw)
Number 3 colonel'm-. Child
L APorson designated In wring pursuant to Pubic W lw 6eGbcn 4201(3k
3. The survirg spouse',
]a. Tire suMving ancesic manner
3. Any surviving Mid Mandeen years of a0e or dder,
4. AeuNi irg pared)
6. Asurvrving sidling elgMeen years of sae or older
S. A Mail appoidM guardian
T. An Miam )ngMeen years of age or door ended b aMre in the earsb and arm)share dwwt in Mb hip to the demvaM;
B. A duty appointed fidmbry d the estate)
a. A dpw Mend Cr rebtrve who lw executed a written statement pursuant A Pubic Heats lees Sedkon421
10, A chief fiscal aRibar of a wumy or a Pudic Mininblfator Microsoft pursuant to Me Surnagale'B Coin Prcmdure Ach
Me. My other Porwn MOls young on Mod of Me amounted and who has evaded a' nsymbo [pursued to Pi hall
now Section 4201(7)
flnn aii THREE of Me imposing)
W/a hereby affirm that the body of me decreased does rod contain a secretary, Mtlery pea,parent And. regulation implanti
ur.aimtive aviw ana mat.m taco mNed.a were removed priorb Mm exmution of tnbauMMutlon Farm. Fallnnbrwrbve
Milan Wineg W Cremation Men
d sod In loam b Me normal and cmmetary perwnnel.
--P—y Vea =that members have Men Mass to WentldMNBulich
eganding the mmwal ofany wrsorel pmpeM or order Ming avalue""any arson signing allow or any hairy member of has
democratic wishes to mveaae. Pine View Crematorium
romyww
in Mrmpansibb bode removal dmermmal Xema hop the oadaimxva hop Vp remalna at 1M deceased Penwel Wrm hfl in the
baseball or that Me remain win M detroyad by the mend ne pmmwe and cannot W erMved air tnma4anAtii— .
jbme Weby assembler Pine View Crematorium
mv�y to warrants On remains of deCPued.
(li QPTIp Ai.)
Vale hereby memories the named funeral dlredw to pravMa tam delivery 1a and moral by an aftemate
cmm W. Xdmmed Micael In the opinion of the funeral director,and b amend this form W pmvMe the costs name and
am Of Phil aromawinventory.
FINAL DISPOSITNIX
TM pars or adsorbed to mass Ve craned wmeiro of the dewaM from the crematory is:
Name.Singleton Sullivan Poter Funeral Home
AOdme: 407 Bay Road, Queensbury, NV 12804 Phone. (518) 7934459
The panned mmclens adwal win 68 dispwrJ of an Wbxs:
Bunal —SL Marys Cemetery South Glens Falls
X MstV ernes ft ryeon named Moody done May eke possession of 1M1a vented remaH.
Pine View Crematorium aydW to gain pasfesioe of
ovoi w
lhB reranmw Singleton Sullivan Potter Funeral Home Wde0wry
in person of by repulamel mal. Fnwwxanw4 Suranne Canrain
a dri
P lN1 f(Rev. Wri Page 2 of
zz—Oriaatlon for Cremation and Disposition
(Meal the YOew^rel
Vwa understand Met d the mandate are M MInyU v h120 Mn of awMtlon.
Pine Yew Cremat0llUm may datWaeWthemwmin
an immovable instant amen as to,vaMRrp. M1wrowrr
CR
(mil QYE of Me hotoo raf)
An um to toe used as awdsimr for the vwnaM1d alumina has been Nr WM1mn
and is deemdm as follows:
this underNrd YW If the Who N W$mall Y bead Me seem cmmMMl amain.an additional too caaeia may Map wW Mdaivery.
-0R
�rw umYMtelgaCwsd. IM'e wder$bWtlW RroumY Wtdmtlwotlwrvva pmNWd
Pitte VBW Cremate ium will place the enameled remains In
,wau"I'd
a rh d ampwary container rot tlel'rxry.
Thie Authorization Form was pretended by Wendy M. BuliM was executed at
a esral
Singleton Sullivan Potter Furrerel Home
407 Bay Roeq Oue'e Sbuq, NY 12a04
a
®rd N aBMmd by tMM1mery dIIMa ee wMessb N euculion.
Noe have aceiva l a ampkted copy of this AuMwlzatlon Form.
TM Peaonls)dsnN below tsM1a the Fsmonot In control or dYpceltlon,wht by YpndW this AutlarY.srbn Form, d gs)
to Me mauncy and compNaroas of Me IMomatlon couaimtl In tight Autlprkaepn Form men nu or s)MemaasaW.
Signed that Sth day Pf June ,2o 20
Patna Canavan
a ryo. cb O� r
m.admw,m..
wtrxeea: ��
Wendy M. Bulich
a•.+owm.rw.mwerww
10441
Susanna Canavan
Iraosp
MO 1896f(Rev. Ni Page 3 W 3