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Jenks, Marc C. Pine View Cemetery S Crematorium Quaker Road Queensbury, NY 12884 (518) 745-4477 or (518) 745-4476 FUNERAL HOME: _ ' — - -----_..._ RETURN TIME: DATE 8 TIME REMAINS ARRIVED AT CREMATORY: NAME OF FUNERAL DIRECTOR OR REGRISTE�RpED RESIDENT DELIVERING REMAINS,�h NAME: _.. _—CASE p _ TYPE OF CONTAINER: LQ: �✓DTE__„_..,lV)y,{_ /' — PLACE OF DEATH: _—_sy,113 ESTIMATED WEIGHT OF REMAINS S CONTAINER -.._.__._. yam ��sys�j r PLACED IN HOLD: _ PLACED IN REFRIGERATION: ____ DATE OF CREMATION: TIME STARTED; � M /LI M ._TIME COMPLETED; PLACED IN RETORT: _MOVED: y p_ RETORTIXIN WHICH REMAINS WERE CREMATED: - _ oft DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS FROM TIME OF ACCEPTED DELIVERY: NOTE: THE CREMATION LOG SMALL ME RETAINED IN THE PERMANENT FILE OF THE CREMATOgY. State SFW YORK Dewnmeam machos smeoa �ivision of olvlslou OF CEMETERIES °°PORT""'" Cemeteries we Comatose ea agray NY Q231-0001 Telephone 4M14K6226 Authorization for Cremation and Disposition This AUtl =tl n Form most be wmpleh0 antl signals prior to delivery of remains lwcmm0an. Dome 52220 Number'. 64� Cremalmy Name: PirM View Crematory Quaker Rood, DumnMury. NY 12BU 518-744M77 Address °non CREMATION Is AN IRRE Eni1 AND Fl , PROCMS. Cremation is conies out by Fasting Me remains efMe chromium]and Me mnrelner hadlig Me remains into a abbreviation chamber where ttay are subjected to intense heal and blame TM hear and flame will inamnts and wmume BwryMlrrg e.ulxbone and meG4 which are all Nut will be lain affair cmmaeon. Fotlanng uemafwn,Me crematory will lake reasomMe ofom N remove all of Me renchares and toner material hen the amounts chamber, on some minimal dust aM residue will likely be left behind. Tnevmu Mills rateinadmnllandbreignmatenalhan They remains and the in adenlal and foreign material coil be di�as required bylaw, The cremTed remains oil be medune lry puNebed into smell away and 1Nawd Into a designated mnla ner or um. CnmaW mnalm gnerally an pulwrimd until no einglebgi is nrtryniiala an ske ltWue. OPENING OF THE CONTAINER The a malory may only own the wMainerhoe ing the urvcremnted human remains in IimiiM actuarial mxA as to coo rmtic ldenW of the de aO moo enzyme Me no Lowell is enclosed which might injure employees or commit CRm MpNwny. R human ramaim are dervemd in a consumer which a rich suitable Pon momentum such as announcing or nnm casket Me cnmabry will uim Me Me remalos be mined Into a suitable container b M it accepts Me umalm. The epemrg Me wnWiner or Me lnnsfer Or Persian or remains will be conducted before a wtness and will be doe in draft with dgnR/9M reaped. IDENTIFICATION OF °ECE45ED Name m oem W Marc C. Jenks Mental stews: Separated Log Known Addre 62 Comstock Road, Greenfield Center, NV 12833 Plan of oeoh. Saratoga Hospital, Saratoga Springs, NY 12866 sex: ©M Or Age: 42 DOB 4W1977 Doe 0DmM: 521it020 ER'm weight 400 Dexnption of ka nine in vAmn remains ad the Malawi. Matthews casket; wooden bonom cretion container PERSON IN CONTROL OF DISPOSITION (Pomn(s)mawMoldawsilion, 41 WONEoffMfaowiPg) I emNJe are Me deaigm awns M Me demaead dmignaM in a WI or wmften 'assumed w¢oited bursuant to Puts: Heats Law Boards 4201. w'I AN¢have no knowledge that Me d¢ea5 executed a wren game ment awarded A Pudic H Paul Law Sego"4201 ore sit macs ing direction s Or the digrombern air his or Me remai ns and IMg are Me wrsonts)having prorM under Public Heats law Senior 4201 and have Me night to MtWme cremation o1Me remains ofthe bicameral WMurmlatiomhtpb Med""Sa IO2e follows: Marc C. Jenks DOS-10W4(Rer. QW15) Page l of Authorization for Cremation antl Disposition Onsed grant Me rta bowl Nurr4: 4 OBBmdlon parents dow 2 The ldce Pascal ted in wreare rmual to Pk Health Law a20113); e spouse; U. The wMWnq concede pencer, Am summing cello eighteen years of ego se older; a Asurew" OOrem; A wwmmg amel eighteen years of age or older; 5. Alewlulh wronged guargen; T. Any Mrsona) eghmn years Mega or NEIN mrsid W share in the e6Kle and UTo'Were dosed in relaraimace as th UBceaaW; 8. Aduly mounted fled iary of estate'. 9. A dines Mend of Mabve who has executed a wrillm at0ement cAll to Public Heats Law rehon 4201; 10. A color Mosel after 0l a munly Or a publi"dmm6treW appointed pursuant to me Surmgners Coal Pm[sdure Atl; 10e. Any other reOnwM is%Tno on behalf of the dereased and wfio May exKMed a""an statement pursuant to Public most law n6201(7h (I - AUK PEEWIhe heomu ) Its@ herebYalfirm thB1Me b]y OI the de¢esetl dxs not Wntain a eetlery, patlay pee, powercell, reEioadNe implern, of midim d"devi¢and mat any such materlebwem removed prior 0 the execution of his AuMw wind poem Fasure b mnove Ibnr orto Cremationham may result In ha tom cnmaWm and crymal perentnel. ¢�� my al Mat irdeuGgons home b ve been Economy Miller gl wall Me removal Many parmnel woceM or either thing ofvelue wfiiM any peon ggning bAow or any tamAy membn of the Roe view Crematory dewased sense W preserve, is not reacemlble�for Me hichi Of camans norm Man Me containercoalition-onew hom me nmaim MNO decaaeed Pereorul items led in M. / red remains will be desbged by MecnanMlon prommus and cannot be renewed aer X Oremcton. IM'e M1Onby audience Pine Yew Creneary tt�vw+vwW b cremM Me remains Of ma G W eatl. FINAL DISPOSIP ON Ter phone athOKet t0 Phil MY onmlM r Its W m dereesed frdn Me oemmary he Brewer Funeral Hamel IM Name: Address, 24 ChuM M, lsee Luaeme, NY 12M 51"96-2]M Phone: The aemaNd Amain M demand wall be gspaed Mae rdlpM; 11Mknr�C' rson rynedaWedcee mibke edsseatim MMeuemeM rhneins, wn.r am Is adhq+zed to give commission or Measurement Breuer FUm lHone. Inc c� rvnuwnx..w by dedwery In pram or le answered mail. Marc C. Jenks menu 005-189arf Pay Was) Page 2 03