Cabarcas, mamie Easter Pine View Cemetery & Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: AD YL44EL RETURN TIME:
DATE S TIME REMAINS ARRIVED AT CREMATORY: b/gho IEbp�
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
0"0 Nulls
NAME: FIRMS PAfinaCR$ CASE R /� ll3/1
TYPE OF CONTAINER. floWtl �iYY 1� cii/r4ga C-0y4&A(
PLACE OF DEATH: SS OL QFN.t I D:+iKN CI I IZSOL
ESTIMATED WEIGHT OF REMAINS A CONTAINER �y I /SO ILf
PLACED IN HOLD: II AID Ah
PLACED IN REFRIGERATION:
DATE OF CREMATION: L IS 1W
TIME STARTED: IZ �i pQ� TIME COMPLETED: pZ.30
11
PLACED IN RETORT: IL YY, MOVED: , _ . _ J:3 Mi yr,ceq
RETORT Y IN WHICH REMAINS WERE CREMATED: 6,Pro "Pov
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL HE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
York does
�EW FORK Division of MOF..e=rsw
TEOF DIN61 rwl�'NfETER�IFa
° Cemeteries w•unhoanAllow
Timpani:AIM474a74-dow
Authorization for Cremation and Disposition
T"N AurM1mtratlM Farm foul camplOWO and signed prlwb dNlwry Of remains rwmmaOQn.
Data June 5, 2020 Nmn"c 713
Cm Mq Name: Pine taw Cremelwy
Mims_210uider ROWQUeMbury, MY LV� PbOM; 51T-TI5M/7
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Gramatien A umeY out by p4ary the remeiou Of the dace and the conlelmr"me been rtvnelMmb a oema CnYrCer Mom
0teyamsuCie WtoinlensebeataMPama. Than best and flO"will lncbombaM consume emryMing eawplbom and medal,
which an all @at MII ba bRaNrvanatlon.
Following wmation, Pe cromatury will ofte reasonable eRM8 t0 mmova all of the remains add other material from IM Counsel
Comber.bid 20"minimal dust and residue will likely be left Ideal The mmamry will separate motional and drop minimal M1pn
Me remmm and Me incidental and human material Mu be dosed M as mqui bylaw. The cmnated remaire will M nmtanlalq
When Ines small pews and paced into a designated o Wiwor An Cre W minor"pensMy an Material Old no
Singer fragment by recognlabk ad sMINSI NOua.
OPENING OF THE CONTAINER
TMcremabry may only ocen he Consumer hotlNg 00 undmannaW human remains In limited cecumpursom SuCh as t0 wrlfirm the
idsmiryof the Ee med onto ensure Met no material senaoad whir might inium employees ordandee the crematpypN{eM It
human remains an dsllwred Ina conbt"rwhlch M nM suitable for cnma4On such m nmmonWl or rental asimb the
mmMory will npu he that Me Intl" be moved Suitable a Suble container before It accepts Me remain. The meaning of a
mamm or Me hansfer or mmwal of remains will M conducted before a wimem and Mil be do"In privacy.with dither and rasped.
IDENTIFICATION OF DECEASED
Name of 00C sM: Mamie Easier Cabanas Manal Status: Mar
Last known AMmN: "Ohio Avg.,puaensbury. NY IRMI
Plan of Ni 55 Ohio Ave., Oum"buq. NY 12504
Sax ❑M ElF Aga. 59 Door 12/11/1960 NwftoeM gsraarzg2D Estimated weigh 150
Consumption of cmerwoontai or In wnlch Anneal MII the delivered.
Florence Casket, Plywood Corrugated cardboard container
pEgSON IN CONTROL OF OS amoN
(Porsm(Sf vl VUi rid P=p MaF ONE N Ma bsoSol
I wool am to designated peed of the dented dm'gnM In a SO w whom instrument euadd pumuant to Publk
Heath Law SO"M 4201.
OR
.A # IMb hen no Freewill that filed Sx eucuhd awMlenmtNrand purwant to Pu dic Heath law Sector 0201 era
Mil conminal dimN7ns her the d'Bweiion of MS Or her hmai he a no lore are the peaon(sl hating plenty uMer Public HmM Law
SediOn 4201 and hve mane M wthOnze wematich of Me remains oft"demaW MyOurnNaDnshlpto MedolmodIsas
follow.:
Mamie Easter Cabarcas
00SA898-f(Rev. Gill Page 1 of
Authoraafion for Cremation and Disposition
(cul own the by( elow)
Numper:5 Desomproan: A survlvinO SINIM rgM yeah Of al or older
2. Tlieurvinag name ,willingPuBuanr m Public Heats ta ctim a0 w SeO1(J)I
emblem
le. The survlviy dwell partner.
A geurvlNng Chhadnt,mblemn yeem of am or Older;
S. A eurvionO siohnit elOnlean Years of ape or older.
8. A deal appointed guardian,
r. My personal)egmen farm of ape or Older Shaped IN Mam In the estate and who Wore cmat'm madonsmin m they Mmawer,
B. A eulyappolMedfidutiery OlNe Subm,
S. AClcn M1rend Or raleevO WNo lace✓BNled a When sumbenl pdrauanl m AMIC Healm Law Seal4201(7);
10. A Met fil ONmr of a county Or a puts[e]mm6Vator appointed clinical to Me Samue m3 Coun PmwdMm pq
Idea Any Other persm wm m achol on behalf of tho wommemd and who his NlWmd a monnum statement Mmuel to Public Health
Law Sedpn 421.
(wma ALL 1flai of the Npo g)
All Sym mail Will Nat Me May Of the mmaeddm not mminabmbry, W"a mak Mi WIL radeachOrevroarit,
or ra]ioagin Mvl¢eve Met any such mM als ware remove] MOr to ves euoNmo or Mae AUMONetlnn Form, Falmmmove
thi if Sfloor to cm 8lon may mull In harm to Me Orion awry and cremNory pYpn mi.
IAW afim Mm lnebudlona have been given m Claire KmO{Me
Summary the removal Of any PomoMl propel or other Minh of value which My parson signing Wow Or any early memtSw col Me
dereasE]wil to pmaerve. Pine View cre wy
e nth reapmiuima rm ltrermwal Orllarsmim items cope Me wnmlmr OWermmthe comers orma daremeE. Pemdnalx sishlnma
Soc
All
Or with ua remalm mall W Meboyed by Ma cremation Procaaa and unnW m the ri road after croma0mn All Me hereby auNodaa Pine View Cmmalory
uretiv to cmnam Me remains of Me demmd.
Hera OPTIONAL)
lMe hereby auMmue Me named funnel direct W provide for dalbary,to and cmma000 Wan alternate
cromat
edema nocama
uch alternate cnmemn Me opinion of Me funaml director.
and to andMilebyM form provk correct Me ct name and
FINAL DISP081TION
TM Porson aumnzed to Su wthe nenuWm im Of ter demmel hcm Ma crematory is
Name'. M.B. Nilmer tumoral Home
POdreas S2 Bmadaay. Pon Sol NY 12828 Pmnm 818-047R219
m.0 mame rememe orWmagma will be demad Ne$IMlwn'
Iftar any reason the paten named aWWdmas nottab pant ofthia vem rpnyN,
Pane View Cmmabry
w�ama re wdviad m eiee mareeedn m
the romans to M B.Minew Fumrm Home nmamol byifeurery
in mom or by re0h mail. MambF WCWnw
DOS-18981 aPn.M/LO) m•w Pam 2 of]
Authorization for Crematbn and Disposition
femme rogax,ly
L+Ij WJi understand that it tM remeim ale me daimatl x n 120days of vemeEon,
Pim%CmyAMm,
ao�A maydupoxofftR Bins In
an eemievabk menrer, such us by susattenno.
cnFxe ION coxrA xFR0.i
(emu al ONE of lho Audi
_An um fob mad AS a¢nbirer orthe cremated remains has bin purchased gore
and l9 des tad as fdnies
IN uM$l ndthM limeumMMsmallbaddtha$Oreum Rmaine, enaddi 2lfidM imrmyNuMbrdfvey.
OR
> A Ll An um is cot yet purchased INJD understand dad it he um la NMm or othamiaa pmndM
Pinys"Crematory
Awnecwn will plain the ClemaYd remains in
e Nyb tempaery container for bodMay.
They Au uo on Fontxb pmuMtl by Cleve Homonym was exxlneb at
M.B. Kilmer Funerel Home
wv Show
U Fromoy. FontE ,mj NY 12wis p
m
and N agreed by Me Nnenl III AS verses bite Amommon��a
Ame have reMien a completed copy of the¢Aum atlbn Form
The mmnts)ld Pied Eebw IYaAthe pareohis)I n control of itspoalten,who by fight ng this Aumotivtlon Fong aX gs)
b the accu my and amphetamines Of Me 1nbmMlon that mail In Nla AUMonaatio r Ferry and authoi Me foregoing.
Signed MY Sin day of June ,� 20
At Hams Jr.
BS OnioAw.ljueenapury.NY 1280i
WITNESS:
China Konop�lu
11932 +�
Meme Ea9x Cabppe
Ixw++ov9
00S18wf(Rev. 04cm) Pa 90IJ