Frasier, Charles F. Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: ALeEAa OEC RETURN TIME:
DATE & TIME REMAINS ARRIVED AT CREMATORY: �ts)W EOBRn
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
_ Qua "%AO0Ey
NAME: (MAms FZtfTu CASES 1Il
TYPE OF CONTAINER:PLACE OF DEATH: 31 FWATM.I
O"r i P&T MS 01 MOI
ESTIMATED WEIGHT OF REMAINS & CONTAINER id
PLACED IN HOLD: q
PLACED IN REFRIGERATION: 1:)b lIl
DATE OF CREMATION: ry iF/SIrO
,.� ,
TIME STARTED: I ZO f1II TIME COMPLETED: M_&
PLACED IN RETORT: 3C All MOVED: fa AM . 9'K
RETORT IN WHICH REMAINS WERE CREMATED: SUPER Av"iIc
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MDR! THAN " HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
a NEW VORK wp.mn maesu�
gTEOF Division of DIVI OF CEMER ES
OPPo0.TIINITy. Cemeteries OW Mnman Arena
NY 1223140001
nlep a'.(51e)011
wrv.0oxny9w
Authorization for Cremation and Disposition
This Attenuation Farm must be completed and iigned Perot to delivery of remains for aramatlon.
cane'. 0619812029 Number'. 71ia
Crematory Name: Pine view Cremato
Address. 21 Quaker Rd., Queensbury, NY 12804 Phone' f
CREMATION IS AN IRREVERSIOLE MO FINAL PROCESS.
Cremation is carried old by placing the emans of the deceased and gro wrMiner holding Me remains into a uemagn chamber when
they are subjected to intense Ima1 and game. The hxl and flame will memo - and Cmaume everything except lone and meall
which ate all that will be NR after crame✓on.
For deep cremaon,Me crematory will ace reammbl¢eints b remove all W Me remains and other mManuel from the cremation
chamber, but some minimal dust and residue will likely be left behind TheMaine"will separate In idenal and foreign material from
the remains and Me mardental and foreign material win be dlescent of ea required bylaw The cremated remains will ch mechanically
axerieed into small pietas and placed Into a Montreal consumer Drum. Cre W remains generally an pulvedb until no
single fragment as rewgnlaable Am SMIe t✓saue.
OPENING OF THE CONTAINER
The meml may only open Me CMteirer holding the unaremated human remains i0li road Circumstances, su[h as t0 WMIrm Me
identify W the lemesed or to ensure that no menial is anGmel which hight Injure employees or damage the cremaiary property. N
human remains are tleltvered In a container which Is rid suitable terming lon such as cathern al or renal c2i NN
atary wall requireo that e remains be moved Into a aulabacwminm baba it attepb the remains. The openngMa i
conmnamera Metmnsfw Orremmalofremainswillb¢COnducadb mawM andwinbedonemplvacy whdgmlyantlrespe1.
IDENTIF CATION OF DECEASED
Nema of Deceased: Charles F. Frasier mental$team
ma Known Addrea; 39 Fourth St, Glens Falls, NY 12901
plain of Deets. Deceased's Residence, 39 Fouts St., Glera Fells, NY 12901
se.: ®m OF Au¢: 61 Dpa: 1010&19M pateapeaM: O0/IM020 Eathered!wagM; 120
Desenow,of aaMB✓Wnail in which remora art be pane 1.
Florence Deluxe Cardboard
PERSON INCON OL OF DISPOSITION
(Parson(a) In mnfNWd'slxwYion, inin=ONEoffre Mb )
I amNh are the designated will or the remember designated in a MII or wrMen instrument atacuad remained to Fudit
Heats l%N Sedlon 4201.
OR.
love have no knowledge Met he daxaud executed a wrilan instrument pursuant to Purlic Realm tdw Seaian 4201 or a
will screening directions far Me dleposmidn M his or her remains and IMm are Me parents)hmvmg priority under POaiO Heats Lew
e on4201andhove MegNaau CnIDcmmahonoftMremainortMdeceased. MyMormMtlomhiPa Medeaeaesdleate
follows:
Charles F. Flemish
DOS Mailf hme 0420) Page l of 3
Aut orization for Cremation and Disposition
(hears from the list below)
Numaerl 3 Cescietion:Child
1. Apenondeegndedinventing pumuentlo PUicI hLewSacn020113t.
2. TM suMNn9 blouse,
L. The herself domestic part
3. My surviving child member worm of age or olderl
a. AsuMNng parent
S. A sunning sibling eighteen yearn of age or or
9. A irefully apt'nand question:
L My pei mihlttm years of age or older wated to share in the estate and who iLam closest in relat'wrship W the re0.6ee4
0. A duly Alllowed btluaary of the estate)
S. A firm Mend be relative who mesexecuted a wood statement pursuant W Public Realm Lew Semlm 4201(T):
10. A chief fiscal offmr of a sourly or a public administrator achromatic pursuant W the Sorrell s Court Proature Ad'.
Ma. My enter passel who is aching on What(of the teceasM and who has seemed a widen statement Wrsuare to Public Has on
Law Seem 4201.
GALL THREE bitter Malwi
Man MreOy aRum that Me nockidthe deceased does mtcontim a datlwy, dabery pack, power all, radeemlve impleM,
w radverdwe deWa and that any such materials were removed psbrWMe execution dlhie Augemodaon Form. Fellurstoremove
these items prior to immediate may wait In hart Me cnmarory and crematory pnonml.
Ilwe At that infrmal have Won at" to John Alexander
regarding the removal M any personal pmPoM1y or other Mire of valua which any power,will Wow or any money member of the
tlewxased wishes to meaerve Pine View Crematory
is mt handfulfort"removal dprsonal items from thin container o�hcm tM remains MMe deaaeed. ParaonalItems left in the
wmainas wherein 1M remains will tndestrcyed by the commoner process,ant cannot he retrieved immoderation.
�PAy hereby tumoriee Pine View Crematory
fovwury to MomM the renulm MMa deceased.
l(rMiel ovnnnay
"Mae hereby maker"the named funeral director to provide for defwsry,of and orientation ny an slwm W
businesses, it deemed sec isman in the opinion of the funeral director.and to amend this form to provide the amct name sM
"shows of such alternate channel
FMAL DIe eOSRION
The parse uthodmd to mane the cremated remains d the deceased from the vemateryls:
Name:Alexander-Baker Funeral Home, Jahn Alexander
All 3809 Main Street Wanensbur9, NY 128M Fawner (518) 623-200
The uemsW remains ill deceased will be dbpwed of as Muows'.
Bunal in North Caldwell Cemetery
nfor any reaea the Miami named above acres not take pmsesslon of the committed remains,
Pine View Crematory is"Mend to 9we p0saobn of
Me remains to Alexander-Baker Funeral Home WdmNery
in person or W regimeed well u..,..,.mrl Charles F. Frasier
DOS-1898d(Rev. Osrzn) naw Pagai
Authorization for Cremation and Disposition
nnnalNr mvnwvey
Noe understand that If see remama are net claimed wMm 120 Nye of cremation,
Pine View Crematory may depox orne dernbens in
an lmelreuable mamx ¢uch as bysutadnp. ucmaam
CRIENIATION
( iltoNE uRN
wg
Alexander-Baker Funeral�An um be call as a wMairerkrtlwcnmaMd handsome falls been purchased teamms
and is de%nbed all lollowe;
IM'e understand thin it the um p bo small hold the ardsm nemata]remebq an additional had OMtalm may be called MWRAN .
O�Ry
�Ll Anuma net W Wrcha¢ed. Me understand Nat d he um is purchased or Badness provNf]
Pine Yew Crematory will place the chambers remiis in
a rgis lemcerary WMainar for Nlivem mwwwcwav�
This Authorization Form was provided by John Alexander was wercwed at
Alexander-Baker Funeral Home
3809 Main SVeet WarrerMburg NY 12885
and is mords by Me banal dredar as wdness to i1s molten.
IMb have received a completed ropy of this demarcation Form.
This pamoda l baseball babes Islam Me persoda)in commit of dissolution,who by a tell me this A maGemaWal Faend,x qsI
to the aeGunry and compbwvsa W Me Information contained In Mis Aulhorizagm Fomr and aWharimis)Me ferpaing.
simread Ms Mh day of June , 20 20 _
Stephen J. Frasier
39 Fourth al., GIarM Fells, NY 12W1
resew ease
WITNESS:
John Alexander '-
1ww
Charles F. Frontier
I�✓Oera
W318wf(raw, 40) Pope9da