Delamater, Lori Plne View Cemetery 8 Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (51 a) 745-4476
FUNERAL HOME:
DATES ---- RETURN TIME: _
TIME
REMAINS ARRIVED AT CREMATORY*
- - -
NAME OF FUNERAL DIRECTOR OR REGRISTEREO RESIDENT DELIVERING REMAINS:
NAME _ -----
TYPE OF CONTAINER. ---CASE A
PLACE OF DEATH: .__.
Z)6 __y1 K STR 1
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER__ _
PLACED IN HOLD:
PLACED IN REFRIGERATION -- - - -
7o Pr1
DATE OF CREMATION- _ 2
TIME STARTED:
---- i _._TIME COMPLETED: _ EkY1
D ) f -
PLACED IN RETORT: _ _ 7il((M�
RETORT Y IN WHICH REMAINS WERE CCRREMATED.
DETAILED REASON FOR OELgY IF REMgIN9 --
WERE CREMATED MORE THAN 48HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CgEMATjON
LOG SHALLBE ET41 :DEN NTHE PCMANENT FILE OF THE CREMATORY.-
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