Russell, June Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NV 32804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: E.
_- - �o r""'- - RETURN
DATE g TIME REMAINS ARRIVED AT CREMATORY: J
NAME OF FUNERAL DIRECTOR OR REGyRISTERED RESIDENT -jNfL
jvlM RA9f
EMAIADR
NAME
-TYPE OF CONTAINER —CASE p 706
PLACE OF DEATH: ._
ESTIMATED WEIGHT Of REMAINS 6 CONTAINER__
PLACED IN HOLD:
PLACED IN REFRIGERATION: -'—'�—'--
DATE OF CREMATION:
_ L/sly
TIME STARTED:
PLACED IN RETORT: 7 3- --TIME COMPLETED;
------_ :2.Agft___MOVED: _ -.S..PC _Arl 911:1`.[G. /(�b•l
RETORT N IN WHICH REMAINS WERE CREMATED:
ANL
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED ORE�TH N AS HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY
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EWr Division of °A"ROOneCarr,w",can,
STPTEOf fnmmrrte pbze
Gp wu«'^ Cemeteries 99warh' yvzA 111
raiders'
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Authorization for Cremation and Disposition
Th is Auldwarodon Form muse M cDmpleY and signed prow to delivery of rvmalns Air cremation.
Canal Needs:
Adaresa. it Sh y11 NJ ITNr� serene: G18-'}LCS- 4N'iI0
CREMATION IN AN IRREVER BM AND FINAL FROCE&R.
Cmmaficn lac old by placing Ina remains of the d awd and the consider hOkNd Me domains Into w oemal T@r whom
May are subsumed to Intense M1aN and flame. no Mel and RaTs will lndne and um inrytrial ucaplEW nk small,
"Ith am al that will M left after cremation.
Foloxfnp annual lye uamarary will take reasonable efloM to nmwe all Nine reance add other meteMl from the banned"
MmMet,but come minimal dust and residue Wall Will M let Wi 1. TM amatory wet mb incidental and M1YMgn metMd core
ME remains add 1M irckengl and foreign awarded Will be diw dp2uld by am The barrel mmaiM afthM metlian'Y
informed ma small pleNe and random mb a analysed Cwldrenr Mr. Crescent domains wnerally ale PulvMwd uNl m
sltgw confirmed N nonpnluble a skel l nuw.
OPENING OF THE CONTAINER
This crematory may only open ma Wnmmm nadmg Mn uncrematM human mmdnn in limited chrumstarke , such as W KnM1m tin
shortly Dane decHeM or to ensure Mat no mmdel in @named wnion mot alum amployees or maybe to barrel Property, If
no men remains am dellnrW In a condoner whim Is net suitable for maaden such as common III w model wkd,the
nadory will rpulm Mat Me mmdm M moved Into a nuN is came l nor Mlwa It aemphe IM nmaim. TM Waning Of
wnWner or Me bender or remand of w ns an Wconducted Mlpe a woman am aril M core In pmary, wor cloy and Mand,
IDERTIFICATION OF DIECEAMED
Nem@VDacm : gkxSl p � � � MSHW3l !1 JnfLEr�
ustooml Paamc g Wyy$�'.111 IYA+1 A)A JaS44
Sax: ❑M of Aei DOE: 0Z I Deer 0O —g4Dai.1030 EMFwef'NNfiMac�2
peecdpMn INrmblkhneYer is~m iM sell MNtlwrM.
nthmirM2M-1kawsCio)
y o xcONIROL OF Chill
( (MolNawh Or Malawi�CA.W Me MbaMpf
I emM/e am Mein gin agent 0Me demaeM aW M 9 we V wdbm nabuamt amMsf Forward Pubic
XedN dew SerYm 4UM,
-0R
WM1 brve anMMfeage Md to demand command a w n 'nmunnnt pummnt to Public HSNh Us Reason 441 ova
salt Wnlng dmcWw N Me diWolson of he a her mmdm and line am Me Camara)raving prosey under Public Harbor law
Secom 4201 add Nn Me not Or auto&@ cadmium of Me remains d be mama. MyiOun MaoMhip W Me dawned IS Al
rota..:
T K c�a ll
O IfafR-f(Re GIVE) FAM IX3
Authorization for Cromation and Disposition
Green does me tm Wow) 1 �nI
deal t3 DescriptionI ii
1. A person eealgnated In ontmg pamani to Pudk H Use Semen bRaln):
3. l eeuMMng spouse:
L. The worried Mmeels partner.
S. Any survival dude agMeen yews,Nege Of does;
<. A III oarenf,
S. A bunting among moral"am of No or doer,
S. A bWWly eppcial guardian:
7. Any reach(s)euam«n years 0eye or door anWee to ochre In to mbte and Mw lave common in baseball W Moo W
S. Aduly Amended Modest,of to estate
9. Adose Mend or mil You has execukd a sedan statement Wrsuani be I HeaM tnw SwWnA3g1(]):
to. ANiad feed offiwr of a county or a public adminbata eppcinad pursuant to to sunmose,9 Cord PF Um Ad;
tw. My star gsonsom is III on MNg M the thousand and wfio has executed a emmn statement passed In PiMic mean
tewsecaenazol(D.
G�LLyy ALL TIRES W me hallow p)
yam_Mae homey Not and to body W me deaefed does not bran a Absorb degwy,pai purer Wn, ndImmdm umgmt,
or Rdloxaxe dMW and Net any such moderate wne nmaWd prior to Me modem of has Aumon Prom. fanum to remove
taw made prior he combustion dry repot In boom to IN unnecessary and Abnormallp onmi.
_ Indiaaffirm Nat Instructions lave them a m Bn ltbr t
regarding the nmovd of any pdx^nt empeM«oRer MIN dvaue v.M1IM am phdn dgnirg WI An my family mmnLlr W me
daoawd MsM w pmmwn. Pine 11 p' A l P " yt ' h (�j
F nd reWmida rorte ranavd dprd.l Ireme Fwnaa cmWnaramm N�a rmaina W us,aacne.e. P.raAbld ddAbn bn In to
pwdem.rnrwM a.r.m.w wgd W drdeyw W s,.mmenanAprx«e mnd udnabm r.nnowd dFree«ndFn.
�Me Nnay essential pine AJ I LLJ t .✓P m0.itet
to nnomea the deal"W the seasonal
liXLL olaPWMION
Tre Mason amended a ra:ww tla rmraFc normal dNe dx fill tln eemmal IS:
demur: i+M I + oria ,, R4
Aes,aeS,5 4.10 t ^ ' hJ CtlbLxM iii propmr-ati IIi4
Te MMW nmelm d dewed isil W dMpaaed d n Uri 128v1
a he. W ° 1 ) 1(fL OP (^ 1"f).'Lk 40elS"
tlM say,rleml the part al r 1 wWLw n as,ass,me do possession 0 Me orientedvenom.
Y nQ SI i PIn�JC YI1�(1we
fD 1A',\ beutlwkNbgFn paawdulW
ftd ns to�Q`L6111'JJ= 'Sc +�br„o y ��+' WdMM1arY
ewwma W
F twdnAbWrepieMM ran. � R1/«P 'I
M
Oo&1ffie-f w.=15) doll
` Authorluflon for Cremation and Disposition
IMe Mbwip)
—94—me unUwslaM that`X dimensions,Mdimensions,lnele n m ode 1z_C weeds in days crem of ation.
n Iu 0 S llnn�nM�f may Moome M Me remains In
r.
an YnheveNe menw.acth ban edbthM.
CNEWININ COMNNE0.NN!
G ONE OIMe bWwbM
Anum to bused an a wmiMHMe oembil mnYnsM been Wmthesed M1cn
and is Meunbed Me fall
Me understand bad Ntlg Me bba smell to MN Me entire Massenet MIAlne, an additional ri mMaFw MY IYd be defeMY
_ AM mbmtM W'SMad. NYau^d°MndtlW tlmvn Is WndwuE or naernae provided
P' J ' e � Cfpmn�on� reel glands.awMbd remelna In
pww.OwN
.rgNbnlpwaycaXebbrMdWwy.
TYafugwbAlbn F.rm wn CrcHlad by fir,-nx+�+ Alti i.D was exewbd er
m..rotw.m,e
rw n Vl n n t� S1u�-Fn rt� FrF
end i.dgned br e.nawml ae.rw M wM.aa m ita eMwuon.
Me lows naHM a mmpbbd wpy of this AUNwh Form.
TM demands)IWntlned When,lMars the peraeMa)In wntrol W dlyoeNon,when by Weenie Mb AUMorfeelon Form, aXesffs)
to the worm"N� d�counpbbnw of Me Information oonWned In thisAufFwtretlen Form and Me breeding.
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alerted Mb ��drya T a vr, % ,mtZ[Z.
no Of It a4-1" fa�;L�8
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