Woodell, Thomas Pine View Cemetery g Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 Or (818) 748-4478
FUNERAL HOME:
--..._ C . O 5... ._-BATE ... RETURN TIME:
&
TIME REMAINS ARRIVED AT CREMATORY - -
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS;
NAME: . _ _LnYX. . - a._ WIMP r_r/
TYPE OF CONTAIN ER: q
c,r , o
GLACE OF DEATH:
ESTIMATED WEIGHT OF REMAINS & CONTAINER- _ pp'�I II
PLACED IN HOLD: - ---- 3"did ..
PLACED IN REFRIGERATION: __
DATE OF CREMATION:
TIME STARTED:
-- __,._.__TIME COMPLETED: — ro'�AH
PLACED IN RETORT; -_S;D Q GM E_ _MOVED: 'W-
.__
RETORT # IN WHICH REMAINS WERE CREMATED: _
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 4
8 HOURS
HOURS RS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL RE RETn Ni EO ;N THE pERMAN N[ TFLE OF THE CREMATORY
1
BewrlWaraAw
NEW PORK Division of mVI CFCEME Ea
SiATEOr on¢Gmmame Fuld,°wOmDNIT. Cemeteries
Toronto, add g e338
Authorization for Cremation and Disposition
TNb AUMO/Ua0'On Form must w completed and signed prier t0 delMry of realm for diagram.
Date: 08I04I2020 Number.
Cremamry same:Pine view Crematorium
Morass.5l Guaker Road. Gueengu y NY 12804 Page (518) 7411
CREMATION 18 AN IRREVERSIBLE AND FINAL PROCESS.
Lremmion 19 cametl out by placing the Rmeins Mme tleweM]and the rme rent"adding the remains into 8=MBi tl omw Were
May are sAmed to Intense heat and flame. TM hart and Mme will InclmnN add wmume ewpMing eiww Mm aM m 1l
whkh am all that will are leX ever crmutlon.
Panel MmOon.me crematory knit take reasonable eXoM b KmOw eM of the renown a and other maeri81 may me vena,bn
chamber, but Words minimal dust and readue anti likely be IM behintl. TM Gemetoryvnll wparale Inctlmlal erM lofelgn meterel M1wn
tMmm ,ns and the incidental aMforeign maRnal will bedlepo$WaasreeuiMbykw. The v Mabd remeim will tor me amaly
Wldomma Into small piear and placed Into a designated comaiMs ar um. Oaxnabdumalmgwmllyam PulvOr umno
single eag^mnt it KKo ntr ble as skaettlesew.
OPENING OF THE CONTAINER
The aematory may only own the container holding me uncremated human remains In limited arcm u4anres, wch ea W wrifirmme
ill armed set arm ensure this no mMenal a enaaeed which mightmure employees or damage the symetry prowM- N
human remalm am dellmad in a comalmr whlch H na suable An cmmatbn such as ceremonial or rang cmmot,IM
Mabry will "ulm matt remains be m late a$usable assuming Wom accepts flay remains. The cwrg ors m
III consumer he oved or me rcamfer Or removal of nmasns or be conducted More awdrm and ant be done in pri with dignort must
OENTF CATON OF DECEASED
Name M Decrosed: Thames wo0tlell Merall Stab$'. Mamed
Lest Rmwn Addrm:2 CCoper Street 1, take George NY 12845
Maw a Deem., 2 Cooper Street, Lake George, NY 12845
Man MA OF aged
�� 72 DOB: 02/1311948 Data aDeeth (�a8/01t202o E.bmwd W t eigha L
k1ANS ins roman U;Dewipuo¢m_uC`TC1
PERSON IN CONTROL OF D�MN
lForrick In modern mammalian. hVyu ^PVE a ma rdb,rvp)
massive are to de " neat amid dmevetlM ng in all or ' IrMwam mimbf purau AFRI
Health Law section 4201.
V— Whim have no humeri mat me w®wed exe a written instrument pormam to Public Hearn"Law demon 4201 Ora
tContaining Mreaiona for me mapoemon a"is or her rm s and 1we am the wraonlH having at under Public Hanson Law
Section 4201 and have the dgm to eumenw damaged of had remains m me tlewe MyN rr Uonship to me dine IBw
MIOws'.
Thomas wootlell
kerwo
DO6.1898 f(Rev. "it?0) Page 1 of
Authorization for Cremation and Disposition
pnsartncmmeusrxerow)
Number. 2 ceacnpMn: Stsburry
1. A person designates in writing Mail to Public MWN ta.9Mbn 4201(3).
2. 1M surviving spouse',
2a. lxe surviving ceramic;partner
3. My surviving mia engineer "am M ape or older
4. Asurvrving parent
S. Aamusing sibling eghteen years or age or Oder,
6. AlawNlly appsintim guardian'.
>. My Prices)mother years O pa or older succeed to Oars In has image and wM ioam doses(In rnaMrexq to Nab seen
6. A duly appointed county of the estate,
9. Adose mend or relative who has executed a written sbhmenl Outsmart to Public Heats law 5M4on 4201(7)I
10. A chielbal officer O a county or a public adminMramr apparel pursuant m For Sumgate s Court PrrcMure Act
1a. My oMer person woo A acting on caner of tub daceaeed and who has executed a wren statement pursuant to Public Hereof
tLass,Seaton 4201V1
ZAU THREE NrM fiMbtnrg)
NYe thereby Arm that the body ofthe dec9esed dow me margin a emery bean palm.poaM Pll. mountains lmplam.
or MioeSw device and MM any such m als were rtrrovctl poor to Me e¢cuion O the AUMwleatlon Form Failure m moreover
ro'Minn player to cremation may resin In Mrm to 1M cmmebry aft cmulay promised.
(p IN We Nor that inmho scn Mve been given M=MM Bich
regarding the remMm O any Poreotlal prplMy an Marban of value wHM nry parson sending beta or any bamty member more
wmaacmwisaempreaeme. Pine View Crematorium
na nW responeibbt«Ne removal apersonal ilema am me COntaimem«Min Ne 2mmna of Its samosa. Fenenal lino 4M mthe
or Me remains n W destroyed by me cmmaeom pouu and cant torrNMvad after cremation.
777l wlremainsw
Me thwmy amounted Pine Vew Crematorium
rocremauuwre ina Mud Mcuaq.
I OPPCNAL)
ifd Mnbyecesmain nomadmnaml Nrmmldp r,abmda"n toaftcren4tp byare aMxaLL
din of dchalerate misryto Ne opinion O1M luronl dlmaobr,and to amens M4brmropmovldaiMcanxt name end
ederma of such samara crem.my.
FINAL dePo91f1OM
The ppwn aMooaM m redo"6n aendM1d owners a the d am an they paMtoyil:
Nmr,,Reg n Denny Stanford Funeral Home
Address'. 53 Quaker Rood Qummbuy, NV 12i3O4 prove: (518)75321114
M 14�wawiry e.ei.pw,pa.fwa..:
Kl itl,A_ In1 1L.
likens,(seam Mat Mmon mined Ywedove rottub Iwueion orIts paneled n m,
Plan Yew Crematorium aaOwd in gore powewmCo
has remaim to Regan pantry Stafford Fronded Home by delivery
In parson or W registered! man. Thomas Waotlall
DOS-dom f(Rev. Wm) Paul
Authorization for Cremation and Disposition
l(I the whownss
w7 Mild endeTnnd MT H the rem9ms are not dame !warn 120 days N uamaHcn.
Pine Yew Crematonum may dYlwys 0Ma demand in
an lmRMevahk manor,yeah w M dumdng pwwo.em
CREMATION COMAINEMNMN
(I�QVEOItM Mbwirq)
An um M he sand as awmelmr for Me demied!remains has lean WrcMsa l Gem
and Y dexAhed as lmlews'.
NWe underidld that 4Me um Ydo Smell0 M1d]Mn snore amulM smWns,an adored mend demands may 0a weal Ord dimYr
�M um Y Mya FwNwd. NYe uMnaleM Mel Hm um Y Wmlaeed w WeiwYe povked
Plan Many Crematorium we place and demanded remems In
mrwo.rm
a NO remWmry weaker for canary.
The Autlwrludm Fam win demoted by Wendy M. Midi was e,stwed at
Regan Danny Stallard Funeral Home
M Guaker Road,pueansbury. NY 12SM
and Y named W Me Nremal dlrMw as wlthws to He executed.
lMe have dendlred a wmlHeYd wpy 0 this mainstream Fom.
no "names)ldsmmed below When He demands)to central of dismantled."a by signing MY Augamaum Form,dreams)
M Me accuracy and comlmMlenms M tlw,inrmmadan demaMM In MY AUMal atlon Form all a dhastmals)Me Mrngmas.
Signs,MY AM drym June 20
Lori Woodell WOOQ
2 Coaper Street Apt 1 Lake Generate, NY 1280
otait
omwaxn. ate.
YInMESB: 11 \\ ,, R
Wally M. aulicls ` Ay 1 L
18461
Th mas Woodell
WS1Bear(Rev. 04120) Paee]M9