Surprenanat, Elwwod D. Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: _ 4 RETURN TIME: IQI'S
DATE d TIME REMAINS ARRIVED AT CREMATORY: Widw 24tIl
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
264d rEuy
NAME: EItI1uD 5orfREAST CASES 72
TYPE OF CONTAINER: a 4 /L Pig Iffia
PLACE OF DEATH: PAY f4 AjI 1
ESTIMATED WEIGHT OF REMAINS 6 CONTAINER 12 IV 302IL� (5 Aje)
PLACED IN HOLD: 2 :64 OBI
PLACED IN REFRIGERATION: L
DATE OF CREMATION: 6-19- zwS
TIME STARTED: TIME COMPLETED:
PLACED IN RETORT: /D3Q- MOVED:
RETORT # IN WHICH REMAINS WERE CREMATED: �S, feyOn..l�_f
pak
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE:THE CREMATION LOG SHALL BE RETAINEO IN THE PERMANENT FILE OF THE CREMATORY.
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