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Boardman, Mary Terese Pine View Cemetery & Crematorium Quaker Road Queensbury, NY 12804 (518) 7454 1477 or (518) 745-4476 FUNERAL HOME: _l .J 4 `�RRETURN TIME: DATE S TIME REMAINS ARRIVED AT CREMATORY: I t - 4-17-ZOZd NAME OF FUNERAL DIRECTOR OR REDRISTEREO 0.E5101NT DELIVERING REMAINS: -2n116Zd 62i NAME: In A_�1T B cAwd82 / CASEC 7Y3 TYPE OF CONTAINER / e A L...,( 6QV 'JZL.bdLJ ha6e '/ a ,55 ,dz4M�p O V' ESTIMATED WEIGHT OF REMAINS 6 CONTAINER uth PLACED IN HOLD: PLACED IN REFRIGERATION: L 1 DATE OF CREMATION: Io)1/i'IA TIME STARTED: 270 Ah TIME COMPLETED: a ID:j,AA1„��eF, PLACED IN RETORT: 940M'I MOVED.- RETORT R IN WHICH REMAINS WERE CREMATED: PF. AhT DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN AS HOURS FROM TIME OF ACCEPTED DELIVERY: NOTE THE OPERATION LOD SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY. OeparNr.nlufem. NEW PORK i)IVISIOR of pNIS10Or,C11 rsz1 rrE Fare orooiRNm. 9Va commercenaaa Cemeteries " " " woolrtvrzne Rvic," zz5 Authorization for Cremation and Disposition Thle NMmenlon Form meet OF completed and around Prior delMq of Remains for corrosion. ml1YM0 L13 Date. Numlep Cremalrry Name'. ssma Very Qen PMmss,_ 310uker Raw AmnuG NY Ra% p� (518) TaEaaT/ CREMATION IS AN IRREVERBISLE AND FINAL PROCESS. Colorado N wniw out by Owing me symne M the deceased aM IM mnbrRr noNlre the homes aw a we non OM x M they are aageoved m intense meth am flame The beat and Name wall loelmmw and eaneunw a a en ing sweet bom and Rehr, whim are a01nat will be 4N after emmalon. Following cro mabon, Ne cram0ory will take brochure eMnsto remaW all Mtle remmus and other material from tee Pernedon chamber,Out come minimal dust add residue will likely Ire aft Whind. The rmrabrymll Wuab Inutlenlal eM bbign meMnM own ueremainsandteeiwdenlalandtw nMWM1Mubaaiepmwotaarpul by Nw. ills aremaled mmama win meNmSYlh "werverdrmo small probes and plardev o a desi9naW Mnmrmr or um. CrNn remains 9Mrmally are Organized lined no single irequest In reaomnlaabN as skeletal dome OPENING OF THE CONTAINER The uematary may only open the comes com ner lowing the uncrem human mnaina'm limited tlmm uamncou such as to man me idenNyotllretlm sed orb anwre hherno mmenal a narrow wnlT might lnryre employees wtlama]e the creadi gopMy If human emtlns am claimmd ins container wMoh is way nuMble for cremation solve u Ommonlal or ran al aa$ki SN atop will resume Min m ted remains the moved tl I a sulmble mrNlner b m It aRapm ma mmalrm. The woman Ma crnmrne r me border or ramwtl of remam will be conducted Glom amass and wrll be time In areas with dignify aM Malawi IDERITIFICATION OF DECEASED Name Of Mmmed. Mary Tnge Soer6nan Mental Value'. Dlwr GBI Known Miami 914RY Row,Aft 31, Saudi humid,NY IM mum M Deem'. 9 Oft ROM,had 31, Ue a Spmga, NY 121IvS Sex: OM ©F Me, 86 me'. 09/20/1933 Dam MOeem 0&t5.2020 EMmamd Volifd normal of G mMaimrIm wMM remMusell G(MI1Wrw. Cardboul Box wlVJooden Base x (PmoMr3 b wMwaw$pnrtdm, �oNEorMetmomy) emMb are coed gn pond M tG deGmol gwdw MIn a sell on w n instrument Forward prruant b Public IbeM law Season sary. D INJe have no knowledge that me dMmsd emaabd a wdown rmWmam puri to Public Health law Section 4201 on well containing bireGme For"dlsposNon of his or her remain$add Have are Ma Warrants)having pounds urban Public Nmim Law SBCSN 42DI and have tlN r9nt b aumar¢e comaeen of day remains o1 Me d� Wagner lelaership W So deceased Is as role : Mary Teresa Boardman Do618i(Rev. WO) Page 1 of 3 Authorization for Cremation and Disposition (InsaR ham me for be ) Sin) Number:_ Dampron John Boatman( . 1. A grant dnlpnetel in venting pursuant W Pi LeeM lnw Socron 4201y): 2. The wervi spore', U. The vmruing darel prefer, ). My wrvrving cold eightgn years at No or other. l Asurming paten[ S. A survtnng abliq eghten years of age or owes S. A away appointed Warier: L Any pul ingnben from of age or older entred an MOM In my@9 and uM Wee tlweat In rele(pn¢ntp to ME demaach: S. A duly appointed gateway 0r"estate, 0. A dow tend or rela0 al he$amoc a evert,comment pumuant to Pubic NeaM Law Began@01R): 10. Achief III officer of a WurTy IX a public ad in en ruW appointed pursuar W the SuMfgate's COM Prcgdure Act 1N. My Water wool am of marg on to if of tree dewesed and"a ages executed a men sb@ nt Wreuent an Pubic HxM Law Eedlon 42019). IfEBEALL THREE Mme Wowing) —e#_INX Mreby arm that 1M Wdy 0Me Oswawd Mere not wndm a WMry, bal paG, oOwIN 0.Yl, had1cadme imi critical tlevlq and MO any such manownwera removed pricrWtlrem on of MMAUM afion Form. Falluntnmmne Nese Ibm pdwb cmmatlon may maul in him MMa cnmlay and emmabry Mmonnel. IAYe am"Me ins nns the warn motto Rolland. Ha reading Me removal a any grsonal property or Or thing W fell union ary Wmon agmng Nam any Ngwy ma fOfMe demand wreathe to mal Pone Yew Crematory is nNn¢pmelHB fore Me removal olpemnel imme kdn MamrdinerorM1wn Me remsnadtly demesed. FamcN116ms MNIn Ne wminer event tre remains Wil he destroyed by the cmmaWn proem ant currency We MMaved Whim cMMmkM. We hereby adlaw" Pith Vl�CmmetOry do rnmam the remtlrm of n»dwemed. (ire MOPTIONAL) Mee twenty,author Me rmmed fumnl Bill M,provide for delivery W and cm eon by an alNmab nm=R.If de "nwmsary In to opinion 0 Me funeral tlirwbr,and ta amend MM form to provider Me cored name and atldmsMsurdr alYmem cnmabry. FINAL DISPOSITION The gram suffichroged to rewivetlw, command lerwor of Me Recemel M1cm tle contrary i¢: Name: Comwssionall Furerel Cam Mdmy: a02 Ma0e Are., Sarebga Splrg, W 12M Mother (51BI S6aJBM TM um remains of demased vnh be discomtl M We MW Return TO Fanny Ifrr any mwn tly proton name etas days M graw pcmembn of for, ant remains. Nm may Cre MN a eutMlmtl to give w¢mabnof Pneumonia may remains to CanpmelOrey FuwY CBn, Iw ty chlnew w uw In q9M or by reglamretl mall. MYy Tatum Boatman mwwr 00"aarf(Rev. 041 Paget We Authorization for Cremation and Disposition (as has mlwww+v) um,alam mat nn,en,ire are not seemed wtnm 120 ears of Manhattan, Piney Camel may alpwe of My mneM,ln Mai lmonevmk manner, III As by Intel CREWTION CONIAINERIORN GONE OIIM MIcwirgl An um to Me used As a container M tie mutual n®ma l M,[en landfall ma n and is aocdbea as tell IMab nderstand mad iftlN um la W Small to hold me Mass thermalAmato; an scandalrgH seasonal may W used for dNiNry. OR- son i is nNyel WrrlaHl. IMb uMerNrA that llno an is WraAMIIXOderwtse prwidN Pine New Cnmaday µill plain the cemand hill In rvsnucshrm e raid temporary contain for delivery. This ANFWlaatl Fwm was aovAedW Roused G. III was enaW at Compassionate Funeral L rhl Inc h 4M Mapb Ava Boo Spd NY IM wall animal ants wneA dlre l am mN r As e¢¢b is emcutlon and It have Areluxd a compleLLtl mepy W tie AUMwhaMw Form. The pemon(s)Iaentred below sal W p,moMs)In control of dbpoJBon."a by all Na Automation Fomr,tl immi i b me accumry aM compeaneae of W Informal combined In this Aumorhetloa Farm and aoomia Is Me bnpodn8. alemsdab INh say or lum .0830 B�m,a Nlnad.rm - D IT 05 AlcOonald Aw., Py1,C. &MWyn. NY 11218 rnu: maw.w ton / WITNESS: Rolland G. Hong p 118M do Way Tpeu Boadmbl OOS1898-f thev. 0a201 Pal