Gilbert, Machele Nicole Pine View Cemetery g Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: _.
-_.. _... RETURN TIME:
DATE & TIME REMAINS ARRIVED AT CREMATORY
NAME OF FUNERAL DIRECTOR OR REGRIGTERED RESIDENT DELIVERING REMAINS-
riot
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NAME: __ __ -_
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TYPE OF CONTAINER: Ci. � / �-'-"
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PLACE OF DEATH: ._ IWZI,.-.-._ Q __. /�- _IWU
ESTIMATED WEIGHT OF REMAINS S CONTgINER.
PLACED IN HOLD: -..._.__..___ _ -_ _. A Z96t1w
PLACED IN REFRIGERATION:
DATE OF CREMATION: -
TIME STARTED:
COMPLETED:
PLACED IN RETORT! R) Al
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_. �I RETORT p IN WHICH REMAINS WERE CREMATEp: LM P.
DETAILED gEg3pN FOR DELAY IF REMAINS WERE CREMATED MORE T��g HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL OF RETAINEDIN N THE PERMANENT CILE OF THE CREMATORY.
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