Johnson, Marlene ISIIEe View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL NOME;
DATE 8 TIME RETURN TIME
REMAINS ARRIVED AT CREMATORY: _ Qy
NAME OF FUNERAL DIRECTOR OR REG fl ISTEREO RESIDENT DELIVERING REMAINS:
NAME - _
TYPE O F C ONTAI NER /J, p:�: pny� —CASE #��y — �pb
PLACE OF DEATH:
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION:
TIME STARTED:
_TIME COMPLETED: IZIJ{P2
PLACED IN RETORT;
moveD:_- �NJ�I
RETORTpIN WHICH
REMAINS WERE CREMATED;
,__._
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SMALL DE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
New York morm
0O MrrrNYORK Division of nx
�*y Cemeteries 'a.Concrete'let.
Authonzation for Cremation and Dispoo lRon
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CRE"MN as AN IRREVERSELE AND Flx<L PROCESS.
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Marlene Johnson
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AUNodulion for Cremation and DiaposIdon
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Authodmation for Cremation and Disposition
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Wnqubnvb Funeral Care 11
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