Daniger Jr., Anthony Plne View Cemetery 8: Cremate,;.'
Quaker Road
Queen9bpryl NY 12804
(s18) 741-4477 or (518) 745-4476
FUNERAL HOME; _.
$ RETURN TIME: AGM
8 TIME gF NO
MAINS ARRIVED AT CREMATORY;
NAME OF FUNERAL DIRECTOR OR REGg19TEREO � ' 3
�1IU RESIDENT DELIVERING REMAINS:'
NAME;
._._.
TYPE OF CONTAINER CgSEp Yu�
M
GLACE OF p
EATH:
-}—C--Q[,.—S�__6kr__�di,_L�._
ESTIMATED WEIGHT
PLACED OF REMAINS 8 CONTAINER -_
PIACE IN HOLD: -
PLACED IN REFRIGERATION:
DATE OF CREMATION:
TIME STARTED:
PLACED IN RETORT: � - -- ' TIME COMPLETED.
_MOV EO: I�
RETORT k IN WHICH REMAINS WERE CREMATED:
DETAILED REASON FOR DELAY IF RE T
MAINS WERE'
CREMATED -��MORE THAN yg HOURS
FROM TIME OF
ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG
SMALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY. _
New YOM al
Da"r Of t.
NEW YORK Division of gvISpNOFCEMETERlE6
STATE Or O C aPlaza
OPPOR1YXItt. Cemeteries gi ftehirybn Avewe
Altbany NY 12231,"l
iekpnane:IflN066326
Authorization for Cremation and Disposition
TMa Authamaron Form must be completed and signed prior to MIMry of remains for cremaVan.
Date,Jura 5, =0 Number: -710
Creme Name:PMVln Crematory
Address 21 Quake Road OueenaW , New Yoh l2GM Mine: 516745M77
CREMATION I6 AN IRREVERSMLE AND FINAL PROCESS
Clarence is camled out of placing the remains o1 Me d sea and IM container homing the hardline into a GemelWn tlam "am
May are subjected to intense had and Name. That heat and IYms will Im ircMa and cola ovffi gDa COM Met a ",
xTlch are all Matwlll M INN after mmamn.
Followng aeral the crematory will take reasonable efforts to remove an of the remains and other matters l mom Me crenWim
U mber, bet some minimal dust and residue will likely be Of behind The crematory well separate NGoemal and Imelan maleial"in
Me remains and thein6demal and foreign maternal soil be disposed Was reduced Cy law. ThevanaledremanswilM Mani
purverm into small pieces and Arms me, a designated canamern um. CmnaWremainsgemmiMampulW unulm
single fragment N resogntia le as skeletal team.
OPENING OF THE CONTAINER
The channel may only Con the Gmdmner holding Me uo-cremated human remains In limited tiwm humms sou asromnfihm tM
country mme deouthad orm ensure Mat no mate al is enGOaed which might injure employees or damage Me demalary property. N
Iwman remains am delivered in a cp ins which Is net suihbbfor cnmelon such as ceremonial or named cases. to
mmatorywillrsauim Mk MammalnsbemovedintoasukabNconhlmrbefamkac pm Memmaim. Theopemigda
"ner or the banskr or removal M mh ns will be crnduded before a witness and will be done in trace/, sushidignMaMrescxa.
GENT F CATION OF OECEARED
Name of Oeckased: Anmor y Damn Jr. Marital entry: Single
Last brown Address: 22 A Skylark Drive, Souch Glens Fella, NY 12G03
Piece of Death M A Skylark Ornve, South Davis FaM, NY 12MM
Sam. MM OF Aae:51 Doe 03-29-1959 Data of Ni CR-04-2020 Estimated weight 250
Desniptiore of commercial In which remains Mll ce delivered.
Florence Casket, plywood corrugated cardboard container.
PEMN IN CONTROL OF DISPOSITION
(Persons)In ell Mdlepa4 r Once ONE or ere hNOW4g1
I anni are Me dwgn agent W me dttmsed designated In a well or Yemen inerumenl a .uled pursuant to Pudic
H Mdew Section I201.
-OR-
1/ S� W havenoknowledge Me MedeceasedseemedamieninstwmwtMmuaMto Public Heathdew Sed,Dn A201 Ora
all mnttlning diregims for the dieceMon of his orhas means and IM are the partm(5)having parody untle PudiC Health Law
seclUn 4201 and bwe the right to awMrnae cremadn Nine remains of the dewaa Wy rmia nshlpto Madecoasadieu
bllaw
Anthony Daniger Jr.
00&18wf(Rev NNO) Psi
Authorization for Cremation and Disposition
(fmw Me
E 81RMerym8insamnMtl imedx inl2O6 sof Pe Mion.
Pire vim Crsrelory
wa+w�m may dispose or Me remmna in
an ineblBvede menm. such uby etetlenng.
CREMATION CONTNMERIURN
(Nest ONEN gl
obe u8eo esaxTainerkrtMr<eras@Eremein,M1n Mon purCM1ewE M1om 1118 Nilmv Fune2l Home
and is Counted w follow, ry U � Poo do Q�
Iho understood that if Me Wn is to Smell to rMd Me more PNNbd remains, an addibmal nod wnlainer may be used fwdekvery.
-OR-
An urn is net WWrC W, It undwtlaM that R no um 18 purchased or someone provided
PireYiex CnmmOry roll plxe the mended mmmm in
na..rvry
a rigid ha npaery comaim'for delivery.
THIS Autlro adw Form was pwNatl by Clain C. KOrc¢a was evouded st
M. B. pMer Funerel Home uwee emvrm�
1 W Main St South Glens Fells, New VOM 12803
and IS Signed by the foci header as w oe to in exec iai pwl
II have Most 8 wmoi copy MMi,Awhidon Form.
The penonpt IdenUO" bNow Islam tlro perawtp) in contral W disposition, who by signing this APModudon Form,aterso
W the accuracy and complabness of the Inbmradon conplMd In MIS AUMMaaOon Form and auNadaets)the forepwng.
Signed Mis 05 di June p N
Daniel Danger
D Cookloa Hill Road D'wsong Post NW 1282d
Wilson Damper
Pa NbsY Ave, auwnbury. NY 1280e
Affair
re� w
WITNESS: (�
Claire C. Non�p4 m �tQes rK __ c
11932 ��
u. Mlhony Dander Jr.
DOS-18W!Now. 0to Page 3of3
M.B. Kilmer Funeral Home
Family owned and operated since 1927
mbSlmer@klmefuwra(Mmecom - w ..Hlmerjaneralhome.com
123Q1an Suer 82 Broadway 136 Moo Soon
ArayKW 12M Fm Edwaq W 12828 So. Glee Fein,W 12803
(518)6384216 (518)747-92" (518)7454116
Re: Executive Order 202.15: Funeral Director Supervising Letter
Name: Katie Morehouse
To Whom it May Concern:
The above-mentioned funeral director shell be under the direct supervision of Kyle Kilmer
and we both agree to the following:
• The individual is validly licensed;
• The individual's duties are limited to the following:
o Tomaketcevsfersofbodie;
o To sign out bodies; and
o Oversee final disposition
• The individual is aware that they may not
o Conduct services;
o Embalm bodies;
o Make funeral arrangements,
o Sign management fowls or death certificates, or
o Sell funeral merchandise.
• The individual has verified that
o They are currently able to work in New York State and will am willfully claims
any of the lawn in New York Same associated with the activities they ere asked to
perform pursuant to Executive Order 202.15
I= LETTER C�ES TO BE V� UPON THE GOVERNOR'S DECILARATION
THAT THE STATE OF EMERGENCY iS OVER
Stjordbe of the individual Signed of the Supervising Funeral Director
Kna ra, 11� a.z4low.x `I- IS-?ono '!.`tie, -2tYLG
Print Name Print e
AuthoriMig n for Cremation and Disposition
Once fmn me rat bebw)
Number' Deectua n: Asurvivng WIN eighteen years at age or older.
1. A gwoM OesignkE in wall putted he Public HeaRh taw Gecpan 4201t2j;
2. The survrvmg spomande
ga. The wrvivng Momastm partner
0. Any sumving child eghteen were of age or Oder;
A. A surviving pared:
S. Asurviving sibling eighteen ynrB M age Or Oder,
6. Alecal y appanmd Marhall
T. Any pereareighteen yemB 0 age or oleer earned to Shemin the evil and vitro iGme channel In relationship to the deofased
B. A duly appointed fido[iary of me e961e1
B. Adoae blend Overall urea ham exected aunnn statement Pureuanl to Pubic Heal Law Sectror 4201p1:
10. Achieffiaal oRer M a county m B pudic admmistretor apminleN pursuant to me Suncgine a Coun Procedure Ad',
help. Al Ober"rear who is acting on behBH M the decreased are who has executed a written slOement purmanl he Public HnM
FMw Swaon 421
harm All &the bMwirul
— hereby mind that the bony a the de ass charts net mnmm a battery, battery peck, poweran.rardwareimplwM1
crimina a devil am Mal any nut memliBl:wera removed pvrome heal dome Aamwlasaen Fon. Fallunbmnova
crime nrlorao channel ran moult inharm m Me mmM and nemalon ;addressed.rut Min mommo ms have peen given to Claire C. Korropu
regarding Me removal d any pert m"m ar Omer mint avalue which any"non eigang ways,or any family mamma 0Me
demuetl wishes to preserve. Pine Vmw Crematory
Is rat reaponaide br Meremavel otpersoralipme M1om Me comeirrer or M1om Me remB�nedMl tleceaeed. Pemanlihmsleft lnlM
contalne�rr`or^, Mn�Me mnlms will ba destorl by Me cmnaa"proceee and mannot be relfievetl abr cmnatlon.
`-NMp'hambyauMonze Pine New Cremakry
M�.eam to cremate Me mmalne 01 dp lceaaad.
(Inuml OPTIONAL)
VM honey aNharlae Me named funeral dhactorto pmHde for delivery to and cremapan by an a1bmM
mmabry if deemed neces"q in the opinion ofMe Wnml director,and M ammd this,bn b provide Me contact name and
"dme of such albmab cmmabry.
FINAL MMS T ON
The person authmieed to repive me corned remains d the de2uaed ham the crematory is:
Name: M. B. Ki der Funeral Hmme
Addms: IW Main 6L 6odh Glens Fells, New York radial Foods 518.74t 6
The vmebd remama M dented wish be dw"eed d as fdk
Bural SL liaD's CemeMy SO9h Gbn Films, Now Yea
If for any rBsson Mo"rmm rimed eLrae da«net Who p mss in ti the veramd remama.
RnB V1ew Cremamry Pars","ars,
1s 8Wfpimed 10 give {aaemom of
Me ranainab M. B. Kilmer Fu"nlHmw mi»r bYtlellrnry
in"rewr or my regialened Mat Andorra Oar wJr.
mamu
DOS-1e68i(Nev. (al ForMI