Whiting ,Robert Phillip Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NV 12804
(518) 745,4477 or (518) 745-4476
FUNERAL HOME:
_ RETURN TIME:
DATE 8TIME REMAINS gftflIVEO AT CREMATORY: $
NAME OF FUNERAL DIRECTOR ORVVgEGgISTEREO RESIDENT DELIVERING REM :
NAME: y
66
-- ... -_--___CASEp _
TYPE OF CONTAINER:
PLACE OF OEATH:
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER_____
1O
PLACED IN HOLD:
PLACED IN REFRIGERATION
DATE OF CREMATION: ----
-�._—$ ZLItO _ _
TIME STARTED: —_7: jOgtL TIME COMPLETED:
PLACED IN RETORT: _
RETORT p IN WN¢X REMAINS WERE CREMATED:DET
FROMI TIME
OF AC FOR DELAY IF REMAINS WERE CREMATED MORE THAN Aa HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOO SHALL RE RETAINED IN THE PERMANENT T FILE OF THE CREMATORY.
rk SUN
Mans NEW PORK Division Of DIVISION of tEMETMNsS
° °"""" Cemeteries ,hI ,;;ao;
Teleolmon, Iw8cau m
Authorization for Cremation and Disposition
This AUMonal Form must be completed and BigMtl pbrb"IN V Mmalml MMrrnema"on.
Dane: MW20,2020 Number. LM,
Cremal Name Few View CmnN
Pddre 21 Quaker Rocks Ouearsbury,NewYM 12BW phone: 518-746 ]]
CREMATION IS AN IRItEVEnIBU AND FINAL PROCESS.
Cm ion is caned out by p18Grq the Realm Of tan deco and the container holding the remains into B cremation chamber Mem
Oroy are aubpmed to intense heal and flanks. TM bnl and flame writ irvA M and eomume sweet s.aaplWro aM mans,
eaddcb am all that will be last Fort crematlon.
Fonching cremalim, the cosmetics will take thermal elands to wheat all of the remains and other mabrnal from me o mWn
common. but some minimal dust and readue will likely be left behind The cremaftry will mower morn l and Resin March hoe
the remains and the ma enbr and Resign mab(I will be disposed Mn rryuired oy Iaw. The command remam¢fell as meManiuly
WNeuudintosmaMpiece andplamdIntoadeapnMl wan normum. CmnaWre minagammir aw WrwdaeduMI1no
re single fragment is mpmemble as akaNbl pursue.
OPENING OF THE CONTAINER
The crem onry may only open the wmtairwr Oding Me unaremaled human remains in IimRed armmsMrces, well as M¢nNm the
iderNly,of the deceased or to ensure than no minimal is entld9ed which might injure emplowes or damage Me norma y pMydy. M
human remains am delivered in a cot inerwhlah IF nM.mrble for rnmadon such as Panamanian Or recall al Me
eaterypose bursa Or am
IW rmbe mold irMacubs Genders and lacwpb Me mnel.with
Theopening res
mMainerm IMtranshrOrtemOwl W remains WII be conducted before a witness and will Ee done in ptivBCy,wrlh dignity and weapbf.
IDENTIFICATION OF DECEASED
Name of Deceased Retain Phllfp WTidng Memel Status: Newt MaMw[
Last Knmm Address: U Derby St Pp. 1 HWwn Fell, New York
Plamol Dmth: 32 Decoy M'Apt' 1 Hudson Falls, New York
Sex: OM OF Agar DOB: 2-22-19N0 Dale of Death S182020 FShmated Weight'. 1W
Dexription of a¢keVmnbiner F which remans wall be dehowal
Florence Chat pMsCed wrrveated cadbard wMamer.
PERSON N CONTROL OF DISPOSRION
(Perrham))in/�JAn{-'h[d�o/ff8"seumafim, Ru IONE OIpe fiHbamM1
f 'F. err AWOM Me resignation agent of Me Mcea9ed devpaantl In a Wil m women instrument el pursuant M Public
Health Law Se umn 0201.
-OR-
INJa have no knowledge that the deaaud exual a enter Instrument pursuant to PWNaC Heats Lew Section Q01 or a
call comment diamore for the discostion Orhis or her remains and Nve are the pemnfs) having pronly under Public Heats Law
Mai 0201 and Iowa the right to authors,cremation of the remains M Me Mail. MylOur relationship M Me Moe is as
happened
RdRn Phillip YMXbq
RI a
DO$ 1 Bed I(Repo 08115) Page 1 of
Authorization for Cremation and Disposition
fWmY n-emxowirgl
IAYe anaembi that if remains are not calmed vnmm 130 days of comarbn,
w cremator
v may ai.puseane remains In
an nMdevahle manner.such ce by vetlentr;
CREMATION OONTAINERIORN
(IMWONEnrthe Idlowingf
An um to be uxd as a mMainerforme memated emaise has been purchased from M. B. Hums This Ho rat
and le described as folio"
INJe understand Mat it the um is IM smau b hold Me 6rNrc GemeMd real an addiEmal bald comainer may IX dead for delvary.
-OR-
7 /An um is not yet purchased tads,mom ntum Met it do,um is functional and esy i e seasonalPi CremelOry will Finds the cremated remYM1F
a rigid temporary wall for deRvay. ucwvmn
This AuN Wdon Form was marded by Cleye C. Nmopya was asacmeain
M. B. Nilmer Funded Home
138 Main St. WNM1 Glens Falls, Ni York 10803 Ir.,wx+n w.m
eN is ai9nea by the Aral dlrMa as vameds to is,eseationm��'�
INda nova remved a charms d copy of this Amendment Form.
The yearea llMnel below Ielare the pereoniel in control of dissociation,are by staring Nu AUMoriaeOM Farm,aNeet(s)
btlre accuracy and complemental of the Iskirmatlon contained In this AUMorfmi Form and auModa s)Me herself
Sigi arm 30 day pf May .30 20 n
0.veM Friday 7.( po _.
n HMIand A" SMh Glens Fells, Newyork
Amold Wnbry al
350 Lu Road Gamble Nw"mrs
>m
V NESS:
Claire C. Almost r ! K {
119M
Roi PhMp KTiing
aa.aomq
D0S18W(Rea =15) Ppe 3of3
Pine View Cemetery and Crematorium
21 Quaker Road
Queensbury, NY 12804
Authorization to Separate Cremated Remains
Funeral HomeMB Kilmer Funeral H 136 Main Shes. SGF NY
Director Clahe Konooka
Date May 20 2020 Tag No. L65
Uwe authorize the separation of the crematd remains of Robert Phillip Whiting
I/we fuller agree to hold harmless, indemnify and defend the herein named crematorium as well
as their representatives, from and against all claims, liabilities or damages whatsoever which
may result from this authorization.
signature
Cremamry Operator
xvm mu
Autnonzetfon for Cremation and Disposition
pnxrtfmmlHliu nmaw)
Number: ° C Scrp0e Asummon parent
1. Ap andaignalWinwritirg Wreuanllo PUb Hearynlaw5a MQ01(3);
]. The sunning spoux;
L. The survwirm domestic deem
3. My surviving Child eighteen years of age Or most.
<. AsuMWng parenp
S. A sunifie adirg sigh years a age a older;
l
v appointed Member;
r. A"peen(st eighteen years m age or alder emceed to more mine sludge and who Were doxel in raotionanip 0 Me samurai
e. Adutya Pinked fiduciary M Me estate;
B. A of Mend or restive who has executed a written statement formal A Public Fargo Lew Sedlm iMt pt;
bar A mild Ovsl mMxr of a 0omly or a public adminielralm apgvnkd pursued tit Me summale'a Com Procedure Aso
103. Any other pecan who ier aging on behalf Of the dtteexd and who hasexWlted a women sisomem formal to Public Her"
Uw Section azot(T).
dr�gd !L THREE of fly IWomort
/��� iA" hereby Mahan Mat the body of de or sed aces rot contain a batten. battery track power call,microwave implaml
fr o gHe deuce and till such monodrama remav0d Porto the executer of this AUWotlzaVion Form FLlunonmows
Rbased forms prbr o common may nation rm ill In ha Me Par ebry m Parenchymal commodity pera m,onnVote term Mat memaima have been given la Claire C. NampMa w�
1he removal a any xrxrei property or Per Ming a relue Mini any pemmr signing below or any fambv member Ones
deceaxa vdmx to meadows Pine view CrMnmay
is not respOrciMe M mmx!r Me re a xrsmal items 40m the consumer«50m Me rmemains cethe aexxea. Permnel blame roe In the
carlalmer or with Me amens win be desbmyal M the cmmamen pmw aM cannot tat retrieved aM condition.
NIN
.n.r.br Infrared Plan w Commodore
W comes Me remains of Me dttgaNd.
FINAL OISPWITION
The Motor aNlwnaed TO recalx Me ae Wremains Of IM decease nmm Me Cremaory is:
Nam, M, B, Nimer Fumml Home
Address_ !W Main St Somh Gbh Falb, New only 12 Phee: 518-70.5-0110
The comretM remaro a dexaeed wall low dsmW was fdbee:
Burial WUMvde Canterbury
star my reaecn the peon need above time not age,pYxeum or the ve summer.
Rod Vim Crematory
KA++»wmu me BNMaixd Mgix poaxsiiand
the remains to M, B. Hilmar Fumnl Nome nu»vmwmu by deliery
in Meson or by rgw mwg mat.
RcMd Philip lMMlry
WS-1ag0-f(NBv, 08115) m'r..✓mar Page 2 of