Butler, Linda C. Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4478
FUNERAL HOME: _ R/¢OAO nY} RETURN TIME:
DATE S TIME REMAINS ARRIVED AT CREMATORY: V IB I zC / ON
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
ff&) aKWN NG,M 1
NAME: Ir OUQ 6 -
LFitLs CASE II
TYPE OF CONTAINER: VIV EA la 411090 e " f r ''
PLACE OF DEATH: BI G L P L�yl_ y. (req R{Fj
ESTIMATED WEIGHT OF REMAINS a CONTAINER_ )M /A•
PLACED IN HOLD: p
PLACED IN REFRIGERATION:
DATE OF CREMATION: k I1D
TIME STARTED: 11C AM TIME COMPLETED: 9' TOflil
PLACED IN RETORT: 7 SO NOVED: H: INS AH Ah
RETORT S IN WHICH REMAINS WERE CREMATED: fiu mex
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN AS HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREATION wo SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
ent ux
andIof K Division of °°"'"`"'"'""
RE Of DMSION OF CEMETERIES
OPPORTVHITY. AlibN Commerre Pl ue Cemeteries A. I
Twee 1018147"226
Authorization for Cremation and Disposition
This AUNcahapon Farm must be comploWd and signed olor to delivery Of rxnalm for CMM W .
Was 06108,2020 Number, elf
Cmm om Name: Pine View Cramer
Ammu'. 21 Quaker Rd. OueensWn NY 128N Phone: till III
CREMATION IS MI IRREVERSIBLE AND FINAL PROCESS.
Cremafwn is aartied put by placing the remains Mthe academic and the wntainer MYdirp the remaim Into a cnmOon Nembm where
they are Subjected In intense heat and flame. TM M1xl and flame tell im6nm and consume mWMhing excess bww and aviation,
which am all MN will be left ANer cmmetiea.
Following cremation, she uenatory will take meanNbb @ffD s to remove all o1Me remains and Aber material from she monarch
chamber, big coin minimal dug and mission will likely be no beMnd, The memalwy will separate Incidental and foreign material from
the remains and Me Incidental and foreign maledal will be disposed 0 as r ulred by law. The nemated remaim MIlcen9WiM sly
pdv ii Into smell pieces and placed into a designated wnlaineror um. Cre SW in"genemllyampu"m Wurldlno
aI"gM Wgml Is mwmwduble as SMNMI tlaue.
OPENING OF THE CONTAINER
The market may ally open she container holding the unaRmased human remains In antral uwMSN e , men as to OMNm the
loamiN of Me deceased"r to ensure that no nm lis eruloal which might injure emomfor S or damage me mangers Property, N
human remains are delleared in a container which as not%unable for rematon such as ceremonial or min soaker the
amatory will mesa that the remaim be moved Into a gil container below it accepts tat remaim. The Nx ing ad
Wahine,or the transfer or amoval of remains will be conducted before a witness and will be done in p"i MN enjy and rester,.
IDENTIFICATION OF DECEASED
Nam of paeeased: Linda C. Butler Mantel stales. Manned
Limit Known Addrem: 81 Freer em Road, PO Box 238, NOM Creek, NY 12853
Place A Death Deceased's Reaidance, 81 Freebem Road, Nell Creek, NY 12853
se:: ❑M 19F Age: TT DOS; 06/1111943 paleApealN 0 512020 ESUMOW weight 100
Oesvip4M of GakNCOAAner in which remains will be dancing.
New England Cremation deluxe container
PERSON IN CONTRM OF 0 8PO8 TION
(P (a)in mural of dvpaglaon ln�l ONE o/aerdywW g
I8m S are Me dimensions agent A the resonant dawamad in a will or enitle" instrument ucuW pursuant in Public
I1M�R th Law sx 4201.
lMe bake no knowledge that the deceaW necWad a writteniracia rut punwnt to Public Neel law medico 4201 era
Will containing Meadows far Me dlepmMm of Ma or her emains and Owe are the persmis)having pnodry under Public Nwl Law
Section 4201 and havethe fixing iuModss rremad"n oft"remains AMa dereuad. WtOur Mis hip Wthedeuced ism
folio
Units C. ewer
DOSIM4(RQY,Na o) Pace 1 of
Authonzatfon for Cremation and Disposition
(In%R fiam the OW hebw)
Number; 2 Domme kin gurV V nO SCSI
2. Te¢u dM ,gal pa»;Mening purwantto Puba Hab Lew Bedion020fU1:
2A The aumvin9 den cPalmer;
3. Any survrvirg Crip eighteen peak of age Or older;
L. Asumiving Went
8. Aaunivin8 all eighteen yams of age Of older'
S. A104hWhy 8acesnom gumman;
G Any Carl eighteen years of age or older en411ed b share In Me estate and who lance dowst In riMmonomp Wme deceased;
a. A duly al:paimed fiduciary of Me estate;
9. AClaw M"or relative Mo has executed a written statement proposed W Pull then Law Section 0201 pi;
10, Achat faol efiCer N a comfy, or a public administrator appal pursuant W Me $urngete'a Court Procedure Am
10a. Any star namn who is atin9 on bMad of the deceased a no who has executed a wntten statement pursuant W Public Hamm
Law 9ecOn4201D)
It NREE of M Wfb e wirrg)
. W/e hereby at"Mat the body of Me deceased does rut tomain a battery. Went,pack, power cell, radioaste Implant
orradiopGve denim and that any such mN dais were removed pror o me exewdon of this AUMwlaaUo Form. Fallumwmmme
these 0ema prim to crarmtion may muk In harm No the cmm Wq and crematory personnel.
moue affirm met inNrudioea I been given to David Alexander
mv
regarding the removal W any Mmwll pmpedy or other Ming W vai which any person si8nin9 below or any famlry mantel afthe
deceased warren;W preserve Pine View Cremeto
I$not raWnsible for Me removal of personal items town the o'nUlrler orl m the remains of Me dismissed. Personal Nk in Me
ever r wess Me nmel ne wil I ba 4"b yed by Me enma0on process and cannot W rNneeed affair Cm Lion.
INW hanby aumonze Pine Uew Cremato
rc�.M W message the real of the seesawed.
(Went lWTfONAL)
Mu hereby auMasse the lamed funeral dikcmr W provide for dolinesy to and Model by an tlhmtle
ce aWof ill4Such mMdnclfiffistraftoemvurya opimon Of funeral director and W amend Mp roan to provide Me correct name and
FINAL of5P0 SmoN
The Wrso 1Mnzed W receive the crammed kmmns of the deceased man Me Gemaftry o:
Name:Alexander-Baker Funeral Home, David Alexander
Address; 3809 Main $ireet Warrensburg NY 128M Phone: (618) $23-2085
The vmreled manage M deceaed will as dispe 1m as M1llani
Restumto Ydmily
If W any Name Me MI named above does not take possession of the v edremains.
W aw
Pine View Crematory is is a give" on m
the remains W x re
Alexander-Baker Furreral Home by newly
wee
in peram or by affica red met. Linda C. BMW
DOS 1896f(Rev Mrzo) w P"i
Authorization for Cremation and Disposition
49—r�Pa rarowlrrg)
INYe underMnd that [IMe retrans are ran Carl arms 120 Ny$dmmabed
Pine View Crematory msy diwowmMe remain in
an inat iembe manner. such AS by modenre. ms«ur>m+*M
CREI AWN COWMNEWURN
radedONE of the Astrudngl
Alexander-Barker Funeral
An urn to W used as a wnbiror he Me cremedd renal a hal been Wmhesee M1om Pun....
and a described as knows:
Me understand Met d Me um is We will to red Me entire commands remains, an actual all consu r may be used Mr delivery.
Iaw-
Anum 'nnetMepurl , It understand Mn e he um is purchased or amended provided
Pirle View Crematory will pure the cremated remains in
a dew Summer dMdlner M deliver.
This Aulhwtretlon Form was provided by David Alexander was executed at
Alexander-Baker Funeral Home
U09 Main Street, WarrensWtg, NY 12885
and is Signed by the Nneral dirMa as witness to its esicuti n.
Me have received a mmmated copy of Pis Abnormal Form.
The penonpt mandate bebwial Pe presents)In control of chromium,who by signing this Antbowznkn Forma stet
W the accuracy and complednem of the Intormnion demaided in this Amanuenses;Form and authoriWs)the foresoing.
Signed5tM1 e.vM June ego Tom 2q-
M1omas�J. BWer
81 Freeborn Road, PO Box 238, Noi Creek, NY 12853 J
cases
.w•esn...t.... ay...
WITNESS: a
David Alexander
10034
Lirtte BWer
I lS9Ct lRev.0411 Page 3 W 3