McGrath, Thomas P. Pine View Cemetery S Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745--4477 or (518) 745-4476
FUNERAL HOME: Yl p RETURN TIME:
DATE S TIME REMAINS ARRIVED AT CREMATORY: U1010
NAME OF FUNERAL DIRECTOR ORREGRISTERED RESIDENT DELIVERING REMAINS:
360 mto
NAME: Now IIawN CABER 73
TYPE OF CONTAINER: BoC(.11e C" 6 nl+ 4TA A.trwr
PLACE OF DEATH: n 1. /ELL I OEarly! 19 1701
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER
PLACED IN HOLD: ru
PLACED IN REFRIGERATION: 1:04 in
DATE OF CREMATIO.NC
TIME STARTED: _2-4= TIME COMPLETED:
PLACED IN RETORT: ?AAl _ --MOVED:
RETORT # IN WHICH REMAINS WERE CREMATED: $a^i�Y en bS_ k
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG Sxn« OF RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
EWVORK I Division 0t gMSIONOFgrSvvTryES
R D
nPPORr11NlTr. 59 hem Armor
CemetCemeteriesWas an R2TAA' t
Tw.dttw:tsm.»mna
Authorizatlon for Cremation and Disposition
TMs AUMwlzctor Farm mustM C plat and signed prior to aeMery of remains rwcmnable.
Dale: W1512020 number 73�
Crematory Name:done Vager C eatery
Ardress:Quaker Road Queensbu NY 12804 Phone: (518) 145-0478
CREWMN Is AN IRREVERSIBLE AND FINAL PROCESS.
Cremation m camM out by placire Me summer dtle UxaneO ant nn chamber MNmg the mandid im0a owretion WmbrwMrs
hey are subµted to intense heat and farm Tro hart and name hilt mdro Wand wreumds everyMmg human Isms and rrMN,
"tell am all Mat will be Nil of cre don.
FoAWnng cmmatbry the crematory wall Wks momentum all W remove all MMe ream no and other malend from Me cmmmbm
counter, bN some minimal dust and revtlw will likey be haft based. The cremaory will separate InadenUI son human myself from
pulveried into and unemotional
pE�es endand plal mt material dominated consumer cons N and,unn. Curwn�mremains TM vermWd an put uoolmry
h memera
ample lmement is recagnlr+bls as SMIl iBum.
OPENING OF THE CONTAMER
The crematory may only oven the container holding Me unuemaN human mmains In limited circumstances, such as to warm the
eentiry W Me decemed or In ensure Nei as natenal N endued which might injure employees or therm a Me oememry property. n
human mum Ins are delivered In a cantalner which Is not suMi for cremation such as mar anlel or miI meka4 Ma
amatory will requireMd Me amended be matters Into a sunaIslenoosier Mmre naecepW Me remains. Thesperni da
dMomo r ma'ehromp r or removal dreimminswill bewntluded another ntlreu andw N be done in privacy, wit car s rich reepact.
F DECEASED
Me"dce asea. Thomas P. MCGreth Need Status: Married
Iaet Imwn Adamah: l9 Lauren lane, Guaensbury , NV 12809
pace of Dead.. 19 Laurell Lane, Cueembury , NY 12804
sae: I9 t OF Ape: 93 mate 0212&1927 Doted we 011182020 Fihnmd Vreghl'.JJ rL
Donal im tams wnWimr in which lamaim"I Ise Wlrxes.
Buffalo Casket Co. All container
NTR01-Op(Poram(slMantid MspDMPOSMM
SMONEd1M IIXbwMp)
1mattearetMdeWgna gentor Merle Wdeepne inawallw"damninMMeMeu pumuaMWPuNm
Hearth law Semen 4201.
-0R/-�
Tn r VWehamnoxnPedpetMtlWdemaseaexe aw ninawmem Fumuemm NWicHmah Law Section420iora
akawnWinirend halls mar Me aoeuthdnerasiher renal mcenIMare Me plum Narrow
priomyhip WI Um HmM Las
spurn 4zot one have the right to ahnonre""nation of too remains die dew.aaa. Brroar iwdmmma W M.a.ceae.e Is r
MlN n:
Thomas P. MCGraM
DOS-18194f(Rev. Ml2ot Paget of
Authorization for Crsmal and Disposition
(Waenfi fn membw)
Number'. 2 oeecrgtion:S
1. A deeper tl gnaW,n arming Seemed to Pudk HaeXb Law Sxticn 4201(3).
L 1M surrruirg spouse;
Y The surviving domeri pander
]. My surHHng child eighteen years W age or oMer:
l Asuorl parent
B. A wrciving along dgMeen years of age or older:
F. A16el lty decrease guardian;
]. My ryBonls)eighteen years of age or doer eMilbd W Share in tM eegle aril who show do t in drWmnship W Me
B. A Nly appointed fiduciary of me ttdb;
9. A dead friend or wahve who has wedged wrNen stele M pursuant to Pudic Health Led Section 4urC1(7).
10. A MIN fisnl off car of a many,or a WOlic aiminual addressed Wnuml W the Surtoyte s Court PWredum PL:
11m. Any other person who la ailing on behaff of We doceesM and wM has executed a written 4nW t pursuant W Public Heats
Iaw Sadd 4201
bardii ALL MREE dtlre tdlowed)
- •—pa le Number egged Nap Me bdepressedy 0 the depressed opens not contain a ballery,b fte pack, power call. M'gecamimpiad,
of Respond device and pat any such neutrons were removed print to the eaxWm of Me AUM aY Form. Fallun to massive
these Items prior W mYmalbn cosy rMUR In berm W Me oWmal and Cre m rypnonnel.
✓7 IM1Ne ammh thamamagne ran been pivenW mardJJDeSImane
regaNmg the remaval a any parsmal popery or o w MIN dpaw Mind M perm agnNy Screw or My fsmity membx M the
deceesed WISISM W pmeme. Pine View Cremate
W nth re:pandbleroh me rempnlapaaonal iWma fipm me mmaiimr«hod m:manaM$dtlw ap.aesd. P.nbmllWma l.nmtn.
c/oumY,nva�r ur winddrop re tnters will N Samuraiby Me cremation ) aM unmt See M/iaved alder 0nmman.
!1(a/L bus hereby aumaw Pine Vbw Crematory
✓ ' romrxwa mcrossa4 Merenulme(IM Mpwsed.
(OPTIONAL)
Vvn herby au oO the named Wnenl deal to provide Nor delivery to and cnmaon by an abmate
amnatory, 1 deamad naruary In the opin on of the Wrrnl director,and W¢than this Wren W prowler Me correct home and
MM msuch ml OCMMBWry.
FRML g5P09 ON
1M person addighormi W receive the Crenated remains M Me model hwn the Cohn yis:
Name;June a MECaletll
Actress 19 Laurel) Lane, Queensbury , NY 1280 plamla (518) ]91
1M u "Wo remmins OF dermMcell the 9spceW acefdb
Burbal at5 Ng National Ca by,
If for any mmn the pamm naval above dxs net WM Fmrsbn athe vanmM remelm,
Pine View Crematory Is auMbrlvd W she pr of
Me remain$W Singleton Sullivan Poser Funerei Hane by de#vMy
in person or by raBlmwM men. ThOnlas P. MCGretM1�wm�
oOS�lN6f(Rev. 0al Palen as
Authorization for Cremation and Disposition
[vANnm bumvbgl
Will urMarWnd that it Vs remWe are not tlmmid won in lA data arunanti
Pine Ylew Crematory may d'wpwaol Mem ft in
immieveble Interval. such as by ac Hn9. rvw.✓anwen
an
CM nON CONTAINEMRN
Sabi ONE of the blbwbp)
SirrgleWn Sullivan Potter
An um W be mad as a container W Me wmalei nimans rm Gen memesed M1cm
BMWM Gdasblld
l uN WwNOIthe um u too amal m had they may element ramwm, an M MWW NO wMe nay GUMWb
Anummegtyelpurmaeed. lM uMneWAavinmumbpur matlw pmwdW
f Pine View Crematory will i the cremated mmamam
e NO bmpO2ry conew for d mfory. �• c.��d
The AUMw Om Form was provided by Mar. J. Nsimorre was execi as
aYavt
SiNWWn Sullivan Potter Funeral Home
p'TU0E .
901 Bay floed GuaenaWry NY 12804
and is si by the Nne2I director as raves to N extension.
Ii have received a complied copy of Nia AutlwrtraWn Farm.
TG parandi hamAad below,homm the paaaMe)In coal of dNpwtion,w by signing this AUM atl Fwm,aMpa)
to the accuracy and completanns of the ethanol conralmd in Mb Autlrortr n Form and MTarluµl Oa bnpdng.
egned MN 15M Gyol June . al 20
June B MCGIath Qwl
19 L�II -ane, Questenstai NY 1280
m..>emae,e.m ab+a
Marl J. OaSimona L � � Ik\Ylt/1NC1�/
iogt8
Thomas P. McGrath
sai •n
18994(Rev. Ni Po9savf3