Graves, Lisa Ann Pine View Cemetery g Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: R
RETURN TIME:
DATE A TIME REMgINS ARRIVED AT CREMATORY: _ _
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT OELIVE2RING�REMAINS:
" CRsfyBy __yd)sh�lY[y�_
NAME: 1A
A'.Y�.—..__._CASE 0
1n
TYPE OF CONTAINIR __, •'I HNYf ' �
PLACE OF DEATH:
�1
ESTIMATED WEIGHT Of REMAINS S CONTAINER.,_
PLACED IN NOLO:
PLACED IN REFRIGERATION: ___
DATE OF CREMATION: --
TIME STARTED: _— I"2;4f
._.__TIME COMPLETED: _ j' IlRfln
PLACED IN RETORT; py1 - II ll�
1 ' � ..RETORT WHICH REMAINS WERE CREMATED: i_
DETAILED REASON FOR DELAY IF REMgINS WERE CREMATED MO MORE THAN CS HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL BE RETAINER IN THE PERMANENT FILE OF THE CREMATORY.
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ue
OPPoRNXITY. Cemeteries Atwell
Tale e'ISI61066016
Authoriutlon for Cremation and Disposition
ThN AUMorlmWn Ferm must La comp4hE and signed pilot As datNa Wmmalm Strombol n.
Date: 05I24(2020 Number: 66 �
Crematory Name:Pine View CremalVNYm
Address:51 Quaker Road. Quleambuq NV 128(D4 Phorm: (518) 745 77
CRENIA MN Is AN IRREVERSIBLE AND FINAL PROCESS.
Cremation is contend out by pletlng the well of rlmdecemee and me consumer hak ing the remains into a uenaton chamber wMre
throy are subjected movement Mal and Fame. The; M1M and flame will Imdrw M and cousums weryerlrrp mmpt team am metal,
which am all that will W Zell after cremation.
Followingcremation, the chard rywill lake reasonable Whorls to remaro all Wtlm remains and Mer molest M1wntlw tlemeMn
chamber, but some minimal dust am weeks will likely be tell GeMnd TM uemslory will mpaRb Irekenml eM bregn melenel ham
the remains and the ilvMemal and enough maternal will as eepoaM Wore removed by la«. TM vemakd rem.ina Mn M n9CM1miCWlry
rAwneadInto small places and parmi a designated comment or um. Cr Wu inagenerallyenpuher untilrro
singNhagmentiswWntr bleassMi migmue.
OPENING OF THE CONTAINER
The crummy may only open the container holding the unoemalee human remains in rushed mcumMnmes. such as to mnfmm tM1W
ieenbuy W tM dereeuE ono snore bar no maternal la endorsed whim might Injure employees or damage Me wematoly property. N
human remains an Amended Ina conmlrearwhkM1 N net suitable for cmmation such As carem anal or metal usesb the
willr uimthattheramalmbemov lMoasuheblecemmnerb kUeMMe MMI". Tnec niNWa
eson m over thahanamr or remwd W relrei^a ml be convected bWwe a witness arm All he done in pretty wM dignity and demand.
IOEXTIFICAMON OF OECEASEO
Name W Deceased: Lim Anne Graves Merlml emxs'. NBVer Mamietl
Last Nnwm Address:330 Ridge Rd., Quessymbusi NV 12804
allowed Deem:330 Ridge Rd.. Queenabury, NV 12804
Se:: OM ® F Age: 58 DOS: 11I28/1g81 MtaW pear: 05I2=020 FiemWed WXpht:
Ceevgtion W reakeVcomaimr in whitlr remains will be del'waM.
MamheW6 Casket CD. CarEbpand altemaNve conlalnerhw interior
PERSON IN C01i OF DMPOSIIMN
(Porson(s)In outlook dds ,, ak ONE a Hre hAve p)
em/W4 ere Me de6ig^sled egmt W Ne demasM deeipnemd In a will w wmkn inslvnem meats pursuemm Pudic
.
(;;St
0knowWl]e that the discussed aanded awnden lnsWment Wrauant to Pubic Heats law Sedw 4201 ora
brlM diepovtlm Whlsorhermmamsand lMn ere lM1eµ on(slhaving armhyunrear PublicNmlP Law
eNNteauFmwm mMonofMaRmainsdMedeceamd. WMurmlaWnshipbMsdmeasmNm
Lithe Anne Graves
DOS-SMS-f(Rw. MO) Pag° 1 W S
Authorization for Cremation and Disposition
(InxrtFwn th PYbabw)
Xwnler: 6 Dee«iption:Sibling, Valaria Droun
1. N carbon MaNneed in soing idea llo PUMk haaM taw Sacen
2 The wool spouw:
U. The surovme combine partner,
a. My boMNrp child eighteen years Ol ape or older.
A AsumNrp Meant
S. A burol blNlrg eighteen years M Me or older
6. Al awfully appointed 8uardan',
T. My Mnomm egM n year;Made or Oder Israeli to stare in tM"i and he Were dowern normal to the decwW
6. A duly appointed lgtriay W Me estate',
8, rl 'a'relaWa 7 M1abexxuted a wdXen ItYpnal pursuant b Public M lli Law Search 03019):
10. Ache/ I4 or afemur orB publlt admire'reVatoraMynlW pursWnUotM Su]ete'B Coun Promdure AY:
1 MypMBr rsM wM le ided, MMHOI Me decea¢ea ant tMO has exewtetlawrNm etHlermnlWnuem to PWNiC HBeM
I
salvo a2olt1t.TH EMHreltabowa lI eMnby eM oeum end that any such materulwere removed adored Me exxu0on of Mm Meanest Form FNlunwrvrmee
pr rtacnmaMonmaymu InMmrb cnmvbr crenul«ymmmml.
IAd affirm Mrs m¢wama base been green b wasiay VonStattlne
Yl—
malafeny Mraonelpgerty«CVeelXbe of argue which ery mr sil Wkw or am lmW member 0 lM
Mesa - nes to shadow. Fine View Cramatimum
Lateral lcrtheremovalWMammalibmb M1omthew=iinerorM1 HnremainsMMedues¢]. Penoml HHnnleeMMe
[aroaInterpretthe ains MItW lroyW b/Mecsimatlon pocare vM mnnolb raeMvaOabrcmnvuen
n .
m
mby auueela Pine Y re View Cmetanum
p�her,"i bCM1Nb tlN rarnrlm Wae tlrttuaa.
1 QA
Wre hereby managed the named tumral dlrxt«to pravMe fair dallen to and cremel by an alternate
amyrxta gathered necessary in me opinion ofiha formal Meadow,and M depend reed Arm to provide the correct name and
.ddreas of such anemate comment.
FIMAL DISPOSITION
The,worms, wrehor rorepryd de«etnalad MM81M a do Gwase]from the chamatoryw
Manor Valerie Drouin
Mmbss: 73 Cal Path, Gifford NH 032d1D- phone: (603) 38T68]t
The«emela remains OF demanded will W dopoxd aas MiI :
If for any nawn 6n pawn rums]ahmre Mp not ttla pow-evvon a"vwreld ramvm,
Pine Yew Crematorium lau6edm col M Wd
and,mmmim to Regan Denny Stanford Funeral Home by"wery,
pandimb t
m person or by registered mail. Lisa Mne Graven
DIM-10e6-ftaev. MrzO) m�s Illegal 2of3
iiii for Cremation and Disposition
Vm7ning
sraNnW arm demand am Mtlavrcn xMnPine View Cremabrium msyaapasedMeremeindi
Ahmomisiond
r, sum ae W vaVarinpRNsiRegan Denny Semi Funeral
e use/d a�s afurtairw M Me seemed anyone lee been Wrmased bass u.......ines: C fw.!,COYNA �a�-� tLYn —
IMIe ur4nalend uul tlnce un n ma nn.r m Md nwantlre aemebd remains, m My1bW rqw mNelrermay M wMMatlHery
M um N MyNpndmad. qYs uMertlaNgY Nrw um v WxbasM oraNwnise pwtla]
Pine View Crematorium will glee be oemaml ensure
nr.-..om..w
a ripe tan W my wrMiner M Mirery.
Reis AUBwrbddn Fa wmprandedby Cddakly VonSleXlna was esecNM at
fsevnseral y
Ragan Danny Hale M Funeral Home
53 Quaker Road Queensbury, NV 12804
and is signed by be beam deafer as names its emadien.
IMb base rewNM a wmple4J wpy 0 Nb Augw "" Form.
no panonlsHdan O anions,glare Ns,besides) In coMrq or d4pwamn,who by sense Mb AdMrlaatlon Form, wmeysl
be Me uamacy aM COmpinbnxs of Me Mbrmerbn contained N ban AUMwtraaon Form and uNvaelsi Me mrandre.
agM4 qy 24111 4nyas May pp 2020
Valerie Dmuin
73 Ca .
]3 Cat Path, GiNOM, NH 0324&
s...a.a.. +a.s.
Ali
vsa1NE88: N
Cassky VonSteMrM
pww.w..w.nr.ex.ry P�
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Use Anne Grasso
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