Ovitt, Brinda Marie Pine View Cemetery g Crematorium
Quaker- Read
Queensburyl NY 12804
(518) 745-4477 Or (518) 745-4476
FUNERAL HOME: A
_9(Lf.�
GATE RETURN TIME:
8 TIME REMAINS ARRIVED AT CREMATORY. _._.___...
NAME OF FUNERAL DIRECTOR OR
fl EGgISTEREp RESIDENT DELIVERING REMAINS:
NAME
TYPE OF CONTANNIER7
-CASED .__ pt
GLACE OF DEATH:
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER __ _ __-_
PLACED IN HOLD:
PLACID IN REFRIGERATION: ____
DATE OF CREMATION: _
TIME STARTED TIME COMPLETED:
PLACED IN RETORT: Tn-
11
.' --I-2Sf1HH::L_MOVE -D:
RETORTAIN WHICH
REMAINS WERE CREMATED:
p
DETgLLFO REASON FOR DELAY IF REMAINS WERE CREMATED MORE HAN OS HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMPT:ON LOU SHALL DE RETANWIRD INTHE PERMANENT FILE OFT CREMATORY.
New York Hate
Department of State
— NEWYORK Division of Dlvmo"orCo..",,tion am
oTATEM Co..",am
°PP°R1VH1es
r- Cemeteries 99 He 12231 dbt
fin Rwreaa zew,
Authorization for Cremation and Disposition
This Arrowhead"Farm must be comple"tl and signed prior b dative of remains for crematon.
Date: It1r170 Nuater: 104.
Crematory Name Piney Omma um
Address: Quaker ROM Oueansbury NY 128N For (5151
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Corm is®mad M by plaCkq the remelns0the demaeed and the wnleiner balding the remains into a P Om clamber whal
they are subjected to intense heat and lie me.The beat a no flame wll I ncdnwale and consume everything except bone and metal,
which are all Nat will be left aRer mms4Oo.
F011owlc "Von,Necrematory vale lake teammate effort to whave ell W the amein5 and other materiel Rom the amended
dlember,but lame minimal dust art nwdue ulll fkely be left beb'md.The IXNne Wll separate Ncdental and enough materiel from
Me remains and Me madnMl are foreign material will be disposed of me equlad bylaw. The amounted remains will be mechmiwlly
puNerized into small pieces and fmcl into a designated wrdninw or um.Cmmabd nmalr s penally am pulvedaed that no
single fmgmeM M raw lax Or as skalWI Mme.
OPENING OF THE CONTAINER
undandell such as W wagon the
identify of the Emereaead m to ensure that no trimmeden thermal holding le uncrearnated human remains in limitedis shouldwhich might injure employees orr damage the crematory property
human nor amOpW2d In acontainer which Is not ulreble for CMmallon such as wemonial or melMl Malithe
chrearnatcher will requires Oat Me remains be moved Into a suitable"Metal whom Rawepts the remains.The owned Of 8
wmineror the transfer or removal of remains will be Andutled Lalom a witness and will be Wine in p rval path dignify end reaped.
IDENTIFICATION OF DECEASED
NameofDec W: Brinda Mark Ovn Martel$"a: Monied
Lnet Knm Address: 153 Broad Street AM Al Hudson Falls, NY 12839
PlewolDeath 153 Broad St Apt K 153 Broad State Apt M. Kingsbury NY Itel
Sw [3 Mi'JF Ape: 67 BOB: MM911953 Oateal Deelh: 0511111 Ee4n dwel fry
Description a wkevmMMner in which emew Mu be delayed.
(prAol mgroG'P6D fbdTyny F
PERSON IN CONTROL OF DISPOSITION
foverem(af in ccnbd arNpos.. Nlfee ONE Wtla ummngf
aeM/e are the designated euirt of Me deceased d"gwed In a all Or wnben PM mint emwbd WreWM to Public
Health Lox Section 0201.
-OR
"6....{�
lMebmenokm MgeMe1NedewasedexmUMdewnnninstmmentpueuaMto Public HeeMt SeNon4201we
met mM ining graduate for Has dUposilion of his or her remains and IMe are the peeonls) hitting priority under Public Health Lax
SeduM201 and be"the rgM to authored cremation of the remains W Me deceased Narrow mMOfthip to Me dsaeas" I8 »
fellawe:
Brinda Mare Ova
MwemosmaW
DOS-18WI(R" Mil Pagel Or
Authorization for Cremation and Disposition
(brandf bri one ONberowl
Number 2 Deposition: 14A Ira r,
1. A parson designated in wrier "Urent to Public Hanlon Law Section 4101(3):
g. me Cal spouse:
ga. me survimng Comet parer
S. My suMWng Chid ei9Mean yura M pe or older;
A AsuMnng PUNK
S. A auMNng sibling eighteen will of age or older,
9. Alwtluly appdMetl gurinfil
e. eighteen
fidmeryorof the age or
older shipped to airs In the Marie and who Name closest in relatbruMp b one demaaa
9. tate
Aclose Mend or Micron who has execNed a when statement pumuant to Public Heats taw Shinn Qol M:
10. A&ler finial ofiur of a County or a public Administrator appointed WreuaM to the Surrogate's Court Proposal And;
10a. Any other cerwn who is acting on behalf of the demo and who has executed a written S oM purmare to Public HdN
Law Section 4309(7).
(InAal ALL THREE aMy MMmng)
9, Q INJe hereby affirm that one body of Me deceased does not write a battery, haMl pack,power Call, speasctire Iengine
orinterfaces demur and that any sum maerals were removed prior tone SxSWtlm MNNAuMo adm Form. f.nm.m amero
tiaae Items priorm cremation may multm Mm m Necremamry and Camemry pareonnN.
a"9i IANeaMrmthninstu mabavebeengMnm Mark K Parish
moral the removal of any Persona propeM or Cher Ming of value which any Person sainting below or any family member hone
deceasedwishestooreserve. Pine View Crematorium
is not responsible for the remonl of personal items from Ne Container orfrom Ne remains Mne tbueeed Personal Nma Its In Me
Consumer or with tier remains will be destroyed by the Cameroon Proceee and cannot My statement avercremmdn.
'i jZMaheabyauhoria Pinevlewcrematorium
"mw..wN
m cmmam one remains of Me deceased.
FINAL DISPOSITON
T Col eperioras mremiroha CRmeted remelnaMNa tKm6ed homes IXBTBlpyl6:
Name. ywei A
Address'. is Phona / YTYL L1 T
The cemaiad remains ofdeaased will de disposed au follows:
FM dam,. P, o . a mQ(s O"our
Iffir anyrewon Ma team named stave does mlteMs pose ion ortlwaemated famine,
Pine View CMMm Oium lg"hovedmgiropmseasionof
tirl
the remains to
.m
re G Home n —bydaiivery
in person or by regivered mail P...'.w.
Rrinaa Mare an
DOS10904(Rea. Orl xrvmwr��u Page 2 of
Authorization for Cremation and Disposition
(mmelme rouowr�g)
/mow �Irvae unearalane mat urns remame.re na aeimea.nllxn +zo say:xaem.mn,
Pine Yew CrematoMm maydimersofMemmain in
anima aSlemenner. aucnaaeywNnng. uc^ i
OREIM ON CONTAINERIURN
nr-o e o n0�
*V` 0 An amro ne wed as aconmmermrtN memamd remains has been put ed room /'nrlI
andmdescnlalnrelown /l .l plrsl.~re lcla-n
wJ.and.reunatrial if too ummmn small ro this the maim cremw.d rem.me,.n.adigaW npdmnmhw m.ybe used adeoaery.
-OR-
An um is Met An Wrcnased. Weer uMersrand mar if no um is punfeaed or otherwise novel
Pine View Crematoaum will pace Na cmmedd remains in
e ngl l temporary co n al ton delivery,
This Aumoriusan Form"a Powell try Mal K PgIM wave mallet
Carleton Funeral Home. Inc.
5B Main St, P. O. BOX 5] Hudson Falls NY 12839
and is signed by Me se l dixl«as wnroaa mIts eaeculicn.
INJe have rereNl a comply ed wiry of Me AVMorlaetlon Form.
The pnonp)Ids WNlaw Ware they on(s)In Control of dispersion,who by signing Mie Authorization Form, aneeNl
by Me accuracy and commissaries More lnb mMen coMalned In this Autharhatlon Form and aumodzels)the foragmI
signed this a3 days June so 20 _
MiIbN Wltt 00 ��
153 amad Street Apt, AB Moral Falls NY 12839 3�
WITNESS:
MaM K. Parssshh
Enna All Ovsi
OO&l mel(Rev. 08115) Page 3 a