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Benton, Diane Pine View Cemetery 8 Crematorium Quaker Roar) Queensbury, NV 12804 (518) 745-4477 or (518) 745-4476 FUNERAL HOME: _ _R[L{(/ RETURN TIME: ._.. BATE STIME REMAINS ARRIVED AT CREMATORY: _ $)� IID qp� NAME OF FUNF 1 WY4 R4L OIRECT00. OR REGIUSTERE0 RESIpENT DELIVERING REMAINS- NAME: NS: NAME: TYPE OF CONTAINER: PLACE OF DEATX: - _yLS ((BIS�-4i._ ESTIMATED WEIGHT OF REMAINS B CONTAINER ITV p PLACED IN HOLD: ' PLACED IN REFRIGERATION: DATE OF CREMATION: TIME STARTED: --­-A-0—An- TIME COMPLETED: PLACED IN RETORT: _ P_ohAn MOVED: _ _RETORT # IN WHICH REMAINS WERE CREMATED: , DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN A'S,IHOOURS FROM TIME OF ACCEPTED DELIVERY: NOTE THE CREMATION LOG SHALL BE RETAINED IN THE PE RMANENT FILE OF THE CREMATORY. Ni Y irrl ul key EJ NEOF O TAWP Division Of O sCo rya R NM Cemeteries or" nic AERli Pa;w saph, eml4sa Authorisation for Cremation and Disposition This AUNar m Fomr must M cwnplebtl and wgi I bwry N remains br Mmaxen. Data 5/19/20 xmroec 66b CMMm Name: Pine View Cremel OwFw Roes,customary, NY 1221 5167/11M7" AE9eae: Prefer- Castellani IS AN IRREVERSIBLE AND FINAL PROLE% central 'a ume ! out 0 omng Vre rdneis of Me Eemabl I the counsel IroMYg Me rmneina Ypo e<ranNbn wwnEvxlwe Ney ere mugectetl It irMnae Mwana Nma. TM Ira vM nvmew1111rcAmnm aM omsume ewrylnlrg emeaq twos ana meW, Panel cremation ll liekNaher edl Oka w. even chamber Or same ins vemworyd inks reasonable Mtns It remove wletke remains and Nl meieriwndkiMna al chamber Orwee minimal dustand breptda will likely M left behindTneaenuby Mil STheram1 MCMwantl begs melenelM1gn IM remains allIpW sa plkreignmwenal MIIMtl We or requnM by W. The MmwM mrreina se Oa nwalurYalry WNey fta Inb emailpisaMplas i tsens^eie!¢nre'namun. CmmepE mnwmywnralry aro WNarlaeE uMro sirgb haOmarM1 p recapntrabb u ekelMl tlssue. OPENING OF THE CONTMNER Tne Crematory may Mly µ'en iM Wmader ndtling IM terminal Human remains in limited orcumAancom event as W assure the deeply at the deMtlM a we eneum Mat an mmedw is accused Mica mgm injure employees w damage Ise vemaWry pro ery If human m aim an denwrad In a cremation iCh a nW sudable wr samurai aucn as ceremonial or rend oaxeL Me Mm q will Maker euttlro mnwm to moved Ina a WikbY toner Wore haoeprm Ise remains. Treopeningo1a Wnkirer or Me 4a6kr or removal olrenbiNHll M KMvied[eKfe a vilrremm and will real In emsday, wen dgnity and reaPotl. 1TIO11011i'OECEARED Name of oewe.a Diane Benton Mewed saue widowed lHeat Korean Mdress: 6164 NYS Rte. 28, Indian Lake, NY 12842 PIR of Dwdd residence sa'. ON © F Age. 83 Dose 9/21/36 Deadw :5/18/20 Esbma Weight. 170 oewkrnn of aselrmw^mi^.in wam will"M dwwled. McDonald Container; basic cardboard; wood relntorced bottom OetROL OF MMMON (Pemvr(a)mmMrtlNdsync4'wt N1r@I ONE or may awbMrg) I emMA are Me elegant"am MlM da'.e W deagmled in a WE of eaMen IneMnwmexeMed peeusnl W Pubw NaeM Law SMuo 4201. ��Ij OggqF-�a g� I Mye m knowledge Met Me mommsed resume a wream Inawmem pursuam to Publim Health Law smite^42f01 u9 meimrg Mmnone a Me dap08nM^ an him or Her remains and IM ere the pemwm(s)having pnoniy order Public Health law Begb14201 and have1Mngm IoauN eDemeanOMe remmdMedeIXe MyMurnktlonampWMadxeaved Isms Remains,'. Diane Benton DOSISBS-f(Rw.m115) Page t of 3 Authoril for Cremal and Disposition p^wdnom are daleeMwl Numeer. 3 Dowgdm; daughter 1. A peron moignaled in wrNnp ppwamla Pubic Rundle:Sclbnuot(3(I 2. the survlelrg spome: Mr. me groan domestic punier: I. My surat and equal"am W ape Or Oder. A AMaor parent, I. Awvlving soliy egNeee yeah of age or Oder S. A lawfully appointed guardian; i. Any person eighteen years of"a or door entered to some in the eager and "a more defeat in Madonshlp to Me unicameral S. A duly appoimad bell of the crimei p. Aclose grand or relative who executed a will someone puretan110 Public Reagan Law SMion 4201(]f; 10. A cnNr findeal officer of a mu not,or a public admimalmlor appointed pursuant to led Sunogrue a Court Proatdure Ad. 10a. My d ow pmwn who le acting ui affair 0f the Medical and who "a founded a wagon statement Minimal to Public H08M taw Sifamn all (�MEOrpmalLL time nby afire The eddy O(ih0 dKAB950 dower net mnUln a bagery, baglery paJ, pOUP mR radioactive Impknt 0f1a30adHe Mercer and Nmarry,such normal were removedpri rg0 the erecNan of this Audeonfirsi FOM Fellunmrm^ove tlpe�sa IbmapriormcmmaWnmeymult Inhmmm1Memmw andemamrypemonml. Y,{ PaulMMs affirm Val inshutions have Caen given b I gher Me removal of any wM mat poGe'ry or Offer thing Ofval which any qxn agdn0 bebw or any Mary Member M Me PIMP Cm^alOry dec9asm w hi m pawns. Ni N rwl reywitM for Me rem WINpnwrel gkm Mani Me wrmarer or from the remain d nn dewwed, Pamprwl Mmm Ind Intlro opM o�rr will Vem ft will ila"o by ea col MI 4B± p and=m nbewdaMuematlon. PimV Crbnelay New�M'a tiger auapnm to cramam the m^alm IN Ve Wormed. HallDISMITIM The paean aunmd to twin V1e amend manage M the Memaed M1am nth me Me: hi FummI HOMe Name, 057 NYS Me. W. Indian take, MY 12842 515-01555H PGMme: mom: The mode led haeWe0f tlemwM Mtl b r dapaed Mat Icbwa: kill 0 f5nj.s1 n of VIEW cm nmpmam nMrMtave dOee 1M bed IrmeuslmatleOMW Ie11Wm, Pmev cremalorr IsaNN®1 Law gF.s pmm.mrlIN the margins To Miyw FwaN Hans py y p..am..rmm In men or by Mil n®I. rower, e WSLbsuff RWI owl Pagi Authorization for Cremation and Disposition lr ma WW(nlr w) QV fk� demand Met illM/dnerts we MCWmYJ ssen dal Yry6 orOamaEM. ne E,Crematory acw..vr IM'BlWaaedtln mmaYUM enimineveEle manrc,, sum as by utalleling CREIWT CONTAMIRNRN d�QYEWtlre hYowY,p) M =w be um]as a OTtlbw fa the OamMatl remains M been gemmed M1wn and is aeuibed as fOlbwa: lMb understand M K the um is Ira Ma !Is add Me Was pgnaYd nmelM, an q}WW W twaserar May We Made N diseases. X`` a .JT 1\ MunYM.yelgNumtl. I W ndlgffmumla PUNawdadbe Wrvided Nw CmmsIW volt plain time cremated remains in ry..awwary a,gN lempwery dmlalner H delWery Patricia Miller TbY PumorizeYW fain nose provided by was eseculed at 91%1wew, q Miller Funeral Home 6157 NYS Res.W.IM'm IMe. NY 1S jFaew and is stand by de rWa,a craaa as wnmmm il¢wem8on., W!e lwe reserved a mmpletM copy of the AaMaimdon Fain. TM demands)ldeMRM bel")Nam me wmWle) In cannot amaPwttion,wino by signing Mla AUMorizatlon Fast,steeds) W Me accuracy and aanPlebmssurMe Information catttlnad In MIe AUMozNauW FWm and waalmde)Meharassing. sigrledats 19 May May . 2020 Mary Benton Frasier t164 NYS Me. 28, Indian Lake, NY 12842 r I aaa �}w �A ('AbkX nN IAS3 WrrREet: rm+-v,.wr..i r tea'• n Paade War 12M5 J i wwn �� Q IMP Ti J`O DOS-1888-f(Rev. Gi amasses