VanEtten, Phyllis M. Pine View Cemetery 8, Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME:
_._.. _. MpSW
OgTF 8 TIME RETURN TIME __
REMAINS ARRIVED AT CREMATORY. _ ,..
NAME OF FUNERAL DIRECTOR OR
REGgISTEREO RESIDENT DELIVERING REMAINS:
--� __-
NAME: --'
TYPE OF CONTAINER / ".I CASE IT
6 'Wood—
PLACE OF DEATH:
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER C
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: _ — - --
TIME STARTED: 1211 zo—
PLACED IN RETORT: (� IUOry __TIME COMPLETED: 31!DI1 .y1I.l RETORT p IN WHICH REMAINS WERE CREMATEo:
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 4S HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE:THE CREMATION l44 SMALL BE RETAINED IN THE PERMANENT FILE GST THE CREMgTOgy,
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Authorization for Cremation and Disposition
The AUMwlRa Form mans 0aenmpleW and Ygned of w dollverY Of ramana for cremmon.
cam: May 28, yn 20f2a0 / N,mbeh 07
CraMory,Name. t,J Lrtmfoor.
Address. 21 fiixi red/ Qni b � W malf plmre. 5A rC-4✓1)
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
c nsencewi Im nametl ou py plaorg Na moment aloe deco¢¢]aM the mM®ner holding IM mains into a crelr M chamber%hand
Ivey era sanjttAM b imenaenW aM name. no heat and namewlx mdmi end Wr aume evaryNme exentlannt and mi
which an all tMtwin b left a wcremWon.
FolIWng monsoon, the IXemaery will how miooMeeOwtt ID nandi YI of Its mamas and other malemm from the Gam on
chance,be tome mntmal dud and maim,Mil likdy the Ids behind. 1Te camel volt German indwynM and foreign mammal Imm
the remans em me modvda end mregn m alas we be disposed or of malmd Memo, mran mm e cm lemony wli be memorially
p NM mvp rem wars Mercer;and and qa into a close etl confirm or firm. Can d remains generally are pulvedud until n0
aneN 4ymem to mugnimble as Gai CGS"
OPENING
e Nva ebrvTmrey mN Wan Ne wniBn ,homing My fin-onematad barren remens in limited mchumaanms,such as m cri the
dotioty o^malnbFrantltlwmd Ina¢organ¢�or teensurethad no "ewhich la wl[bde led inch mona antonyms rch such in ceremonial the
ennW casket the "
anneme a"t'M hancierwremw3 al'remeb'n6 niA vie minduclr Sin' wadvn!tnvsBamod wYl beW eDinaerremvmelns. Themommora
aw.Mm egnaraedrmpeu
OEHTIFICADON OF DECEASED
nmbd Deceased: Phyllis K. VanEtten Nrld Mewl: Married
Ie91S AMrma: 12 Catherine St- , Fort Ann, NY. 12827
Plaxotl>om: sAme as ab 'M
sin: ON RIF Age: 70 on, 2/28/50 pace of Death: 5/28/2020 EtmdAIwmydm
pmmpddnmmakedmmaina in whrh remains Mu be delrvar. Florence Casket CO.
cod, wood composite base, cardboard top.
PFASON IN CONTROL OF D aPOSITIC
(M1L((S)ma cow asps ,imT'A'One a My
nmcn bnvgf
Ail+ I mile was me designated Agent W On dmAyi dmgnmd in wil or%lien inaWmenl Semi µmusm A Punk
naYN I ow Smbn a3D1.
oR-
IAm red no xwwbdge tote Ae dxswed mmdal a wi mammas moment to WNn Norm Law Simon Q01 or a
way containing directions for the dnFOsxbn of he in I ,rendns and Ywe So Me mmoM s)having Pi amdm If na9N Lm'
Section 4201 and have the ngM b a➢Mfixemematlon of the Mstm of Na dameed MWOur NlaUwhipn Pe Gm dIsas
Idlowa:
Phyllis M. VanEtten
DO$ Agri Mev For 5) pody NS
Authorization for Cremation and Disposition
(InaMhom Ne tlel M4M1
Number: 3_ 0,ndia yn: Daughter
1. A person designated In wi rq Wrslam m NEllc HWIM Law Sedbn 4201
L The Moral spouse;
Sa. The starmno)domestic Panama;
L My sermons cred algMedl Yeats d age of alder.
1. AsuMNy Myl
S. A suMWry sibling algMem was oh hers,of Oder:
). My mes5�)eelgMwn years d age at don sONtl to shaman me Mob aM wed b eas tlnsest in dealers bOmdecrosad:
U. A it*mosenlad flood ary d Ne mMa ;
S. AName Mend a radial who his eucultl a wMlen aldvneO tynuatl to Public HetlN Lax Sell Cd01i11:
10. AdYMadds oN M a artery or a public alninisVMr arytimM pursmM to the Senegal aC"ll Prxeal M:
10s. My other Cason whey is adding in Nor d Na eaLeYed and who ameaadded a wrlonatmxanl partners to Pi H M
than,Sol 42011
(falau 1HREE of Me kernel
®Q]S 1NJa Mmoy ammo lnalthehmdvd thedoe®eemesmwnmlr abdmn.bMery Pack pawar del. remLadweemgam.
or rfdlaac1M06vire and and any anal malerladaw mnamadvad petty the eeewlan OtNs PuUMaatlon Form. Follw MMMOve
ary
l"llam rim to a p co mauy may Msdt In harm ro Us rearaddy and Memory wM "mi.
ORDa'? WJe� m Ndn raOuctionshewd m a
egeor B[UC¢ K. M3on,12261
VJ r�wartlirg Ne remwO deny pxxnd poFeMorcder Pl°�ng dvaluexlnlN xy Cason symng Gelonor enYfxrit/naMxd Ne
Ottoased Wsresmy®erve. ` r
u mlrnpcnadelorlMremwd ol[gxnd llemelmmthe Gnlar�amlmm lMsemaim dlMoer' mM_ Perwnal llanelM In Ne
deviation Or wM Me remane well be deaWyed by Me overallpwresa and dannot Oe maleved after cremation.
®�Me nearby wNorize 1 JiL -ua--ewes
m ari maM Me Mmalns aMeFINAL DImPOSl
dacaerd.
The Maas,nominated!0 Mcave Me uerubY M arm of the deR 0pnthe xar smn Is:
Name: Hruce K. Mdeon
andresse P 0 Box — a'n phone: 518_ 3 —1017
Theo ran Lu adx W Mi eta dspxed d es hady"i
Return t0 family.
if la ary rasa sM Oeram narnvieWe M rnol tieM 5s d me vemaW rmrabs,
Re U ' a awv¢ed by Maelnsm.bnd
the rarelnam Mason Funeral 110a1e midlevel
M pawn or W repnal man. phyllia M. VallHtten
two MovN dome 2d5
1%5-10g5-f(day.of
Authorization for Cremation and Disposition
rmP�M` rdia+a�N
®yL—,Wie node W MI d"mamma aeM dead uddu Mdamd comean.
PA ' mayonda mMmRwnsin
an YreNevaOk a asmann . sun W Semo g, le✓nwd
CREMATION COMA NERNRN
(L�s'1�ONEWNe Idbnvl9)
® Pn um 1p 4e uw memN'�mr(or Neoemaw nm9ina 11w Eeml pwNwMlrcm
d::umasmnase a ua `.ONilRAG
vavalmaaanemMatnn ana Mamaumnpidm�ue p�amaean w.a.aMlw�al�ym mnmmar mayeaww m�eN'ww.
oR.
M an is M you pludlaed. me uMannew MM X an um is gxdwsed Of 'vAw gmidw
d71� MI dace was aemmd remains in
a dple mnpwaymMa'ne�la daNey. aa,✓ Bruce B. Masons 12261
TNS AUNatlltlm Fomlwy gaamw Gy was exemkd at
Irysi gaa,a+u
Mason Funeral Home
P.O. Box 2775 Fort AnnesR4."M21127
d ManAkwm
and is Sound Ey me Name dnwor an witwss m N esaaebu.
IM'e nare named a mmpiaw aOW d Nh AUUwkashn Fann.
Ths as day Penwell)
and casplamrese 0 euffival al loam day elnlmmalmn onM1mae Ins dayl n,wan,by Waning this Aussumumbow Fonss Masud
A udwNelbn Fool mod eulMands)Mlaspnl p
HpneJmis 28th day& May ,ld 20
�s'� .
2 5 Wilbur Rd. Schu lerville MY. 128yi
WIMESE: M�J
Bruce B. Mason
Phyllis M. VanBtten
COE-lug (Rev.OMIS) Pepe3a15
Pine View Cemetery and Crematorium
YI Quaker Road
Queensbury, NY 12804
Authorization to Separate Cremated Remains
riveted Home --------------tOu-------------------—
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pwe zn0arroe die ml:aralon or the acnuacd rennins of
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ywe 6mlwr agree to Luld lunnlexs, indelillOdy and del'oul die Lenin nmucd «enuiorium :u well
m dwi olln<xm:uivoa. l'rn nA ag.dnx.:Jl claim., II::Lllldo or damaµce wleewe Tr w6kL mar
:cs:dr liom iLis:udnninnionA
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Qrnurory Opcinux _--_---
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