Demas, Peter Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: _ _- _ [ P S
RETURN TIME: ____
_..
DATE B TIME REMAINS ARRIVED AT CREMATORY: $
NAME OF FUNERAL DIRECTOR OR REGRISTEREO RESIDENT DELIVERING REMAI
-- U'NN
NAME: _ ..- ..__-S%I_ _47fra - .=_ i-
o� (J1 __ ._. ---- -CASE_ p _,__l(6
TYPE OF CONTAINER; __--YTgFJO.__ _.-- � _ �^ _
PLACE or DEATH: .__
ESTIMATEDWEIGHT OF REMAINS 8 CONTAINER _...__xIPo
PLACEIN
PLACED IN MOLD: _
PLACED IN REFRIGERATION; _
DATE OF CREMATION:
TIME STARTED:
---�1 '1�_.___.. TIME COMPLETED:
PLACED INRETORT: __J`E�VrI _ MOVFO'. .____„_ ( ` y1 fQ
RETORT p IN WHICH REMAINS WERE CREMATED:
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 40 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE:THE CREMATION LOG SMALL BE RETnweP IN THE vcnxnxexT FILE OF THE CREMATORY.
May 22, 2020 8:22AM
: a�� Division of �rcl,la»��M� •r�
��D�D�gym_
Cemeteries
Authorization for Cremation and Disposition
1M1YNNubLM Fmn bYbeapktrd sNabM pMb WMrydrwran M[rt
AN: avztnluD reNNc 44d _
colmabry Name.Pine Mm Qell¢Iwiun
Mdw:51 puakx Road uueamtwrr NY 128d1 Ftv.: f5181]0.Se677
CRn TDN 19 AN laeevex6l&E AND nWiL rental
Crema aamea] MIA Alum MermamdMM[.Y]WNefvrYvv wum;me romans lane a cMYldM.'a Wv¢
"'cx mall
lll Me l NYreverlM ud Nme. llw M1eNrtrtlM WINWrra@aNwnumevvvvNiy mpbow mdnMN.
nxi WII bNYu1pNPMYM,
Fdlmhn9 vema4un,Newemalory Nl M'e RYpigealwp brMave a1 aCermlam uq WernAYNIFdn W uwrv[m
pul,e
cxamber.4ul wme minlmalawlwANWwNIINhbe MrtlJtl. iroambry Nll eaPmYirNwaYluA l.e'pn rrWUlM1wn
Mcmmaiv aaamal Yoaendl !Owed AND a 1.Yl.aleeahpm.ada pna bFw. Treeenum+mrane.:FbrtaMduW
81,311 ealmosmalleamp aaa PY�NNeEMIgrbN mYhwrNan. GanaeYrwralrspenanlh Na pulvB(uNl unYl no
irgl.xaNmem ae reaalulael.r.rN.lall
aeeNMcori couruxm
nor aamamry may momv Non woman ndaaae m.ra.e<mNm xuKarnaglly an wmim orormeaaeea,way a to m,mamx
Ih,pon ornaursa &wluamurt Palmmaecle errcMHMk,ler nLae such AN wool
mage me werramrypothM lr
arc Del IvereE I n v mMYM NaM Y M vuihbk b eaa W a auex n mwwn Ivl nr nM I euY(the
mmalory xXl mquam Ino1Me eemaM bemuwtl kbavOYYYmr6iarbimaagp6 Ne mneiN. Th¢OWnirg Me
mmarcr orixe vane%ror remora alameMvnuxe mW�bFAaNINNYdaMbdare lnpMxy.vM aie�M one looped
IMNTFMATION OF DECEASED
Nmd� Peter Denise WDNI SMv N{arliea
tea AJLam N Win Street, Queemstal w12
pealloDeaea: 0 Win SDeet, lhcemEury, NY 121104
Sw ®u 13F Ap. 92 DOIA D&2T/199) b1aa DWlN D6!!y@O2O FAImFtlxahle�`!o tL
IMptllm a uFYbIYs n N WJI INnMa ve CC EPAF W.
pNwoNacaxrnDLaFvwwrrtoFl o
IpaewNU Y m1 W u'auwam,,h9'a1 uve aoN laa W am
I YxWe,Are uM dyruW polar IN hsaaetl tlwyW!Y a Ad or winfien immanent Wy,Am Pusuam to Peale
IlaNwsaawwt.
ce
�— wpa llaalnYrawaeeeweNaeovran:xF.e.wa.I lara.I�eN.alwnm Fwlmla.nn lea seaaaa a2N,..
ra mlb:Ie a.d W n b 1.�waoaa a Na n For Ivam..ae m In m p�N br+a Innnh unmr wxa�F��
saabaa2olaW llmmenvlrtmadlma®u.nemdereleara¢auleeeuaeea q�waNaumexlplo u.aaa.awlYaa
am:
Peter Ninas
All...
Oostlmrp+m.ouml Pape 1 a3
Nny. 22 2020- 0.23AM No. 0509_P. 3_
/euurultrxdan mr CreffmU nand Dlapmldm
nnmdrnnaeradmt
Numm� 2 ixanbdon Spouse
1. A prmmdenniIn wing n,nowielndnad ImaBMan4Ntnk
L mn[rtwaneawm;
u. In a6naaYa dmneaoe nanrnn
x "somm's al to egmar;inn a ate olowv
S. A suni[Irg rdvg agMeen pen d[pe a older.
6. A Iowei ggoiANa gumrlan
i "GmwK[l egnk¢n yvn a One or M' noYM b~in Me aYA[and WO Nnrt demand al N pan Van drain.
I. Aduly a nx,ma Nx Id Ma afte;
A. A came Mend m rtlaem wn lw ereo4d a rnden awned pnuam an l+mle tanaM lr[9s1bi J1p1(IF
10. AdiM6aolomnrMa¢nMyw[ryMcamvutlNyyv"KM pnwammtle 8urto$ak'[Cda1PfOCtlwe Pc(
Ma. lM'dM1x mnsm wfiaY tiM on indeed de dweW and wine aft moment a earn attainment Wind b PWi meaM
Ix ArMm cdtl a
All 1HREE of ld mhq)
Wve wood,14mtlet Me MN N Me demand bw[Mmdim a ealrey.E nark nown,W.MOLrvoirpwit
w M[x9n aeNaaNtlateny[Ai mmnYa[en rmoMplu blteewMun WmYAutlpriaetbn[inn. Faiinb mrow
tlaw Rene pbr m[me0[n n4y mull Y Nnl b tl nWMwy aM nMby lersmn[I.
_IN/eaMm awln.mmio-ry nanbm amnia Neh LmhollAp
ryMg tle nnwl d airy ymel peep n dM gbp N nM MRa airy pwn apuq Mcw a mry M1MII nerrpr d tln
e,®m.an.bpme„e. vine Vkyl Crentromm m
Y ml re{dWe Mee remnyd�aotY llnfmmtlwwngM1lxaAentlrtrenwdMede®f 0.rmrell Min Me
mimfnw ar rmm nn mnwro wai pe anry.e q ne manutlnr pom.bad unnd ee Mpeaa.itr ner a
�/�.uweeanq adnwY[ Rrle VIM Crematanum
� b[nmeY Marmnaln MMsdA'vmN.
_µel Mnq eMcue Me namN NmM dinMei pov6Je lnr ae,WM to and 1,ft iganaeemaR
nanni YopnM rm,memy in Me odngn a Me inner Mniaae,ad!tomanna Me Wool m I Ide de mmtl nano ad
wd�dee[n aroemm ummmy.
rwu oviroartwx
lee raaUi wYvmtl m one tle Pe�mIN rarein Of Ilw dmass il M1pn do oematnY
aaee:Regan Oenmy SWIoN Funeral Home, A J. O Maaana
Aadt M Qnlow Road, OueermMrty. NY 1=4 Ran; (51e)M-1114
maaaYaa.eeaameanewi rodewredrraaw,:
eudel-5vatogs Natko lCemetery
aMma�a 6wwmrareG Wowduna W µwrMdMawnWdimnaba.
Rmaew pamat b.emmbyee{vaalMrd
remmyem Regan Oenm Sitlfad FumM Hone Mawr
w.an..eer.a
ma[mwgnywiwma Peb OMms
ooatefium r.aarm) �•vge:da
Mar. lz. 2090 8:23AM No. 0509 P. 2
Aulhorirallon for Cremation and Disposltlon
�beaFon:pj
G+�✓MuvYNbMRnFmieeeznM SneEx19n 1a1eayzgemiFEu,
Pim Vlaw cmmna ua �v/YZRaznatl�annslmb
aibetlLrabb re.M.,aun®gFaunN. �"
CRFLnl1OX a9xr
�out:abnrmway
Mwnrob tlwambnxMManarc4q remiu RcpeanpeUzzzelmm
aq:ewrne.e sNlc.n
LWeunMmerq WlRlpunb MaMbMtl ReMie eotnYlnmYR,nzdnvW NiamgYrnW h�uW Ma%wry.
K�MionbMMWd�aa RWe utlaawtlrolMmunbpntlipJadbawe pWarJ
Pine Cn:metbban na Pambeuana�imairsb
•rW yryveymrWixbaWwy.
mb Ywalorbn FawwpwMFab Mark J. O Imons xaz..r<�reem
m� uur
Ragan paRiY S1eRdd Fureral Rare
63�uaka R=al,Z ¢bury, NY 12
M1:FMnb q tlb nx.w gn l0l w MYxu b lb mapn,'www
NM M1m�va`M s amzY.tl rcq d bL 4NybrtM Fwm.
Tb Raannlzl�eegaba bJa:dzrteypwayal innnnbd gaypylbn,atnynlaninr Ns.zuManze4vn Foam,atlespzl
rotlwaQur yenaw�im�e.cau.:rtonn.mn wnbinea�nw.�wn�aanronnana vmna,;rt(a tm a,.�a.a.
abmaaaz 21s( Mwd May
Helen Dbnie LPN /�RMtr �'
N Main Street, Dumnsbury, NY 12&Sa
wI1x6Sa: ._
J. peai Q
i 10ai9
Peter Demas
n..en®R
0.'P 10tW(Rw.W30) Fap9W3