Orofino, Paul P. Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: _ fNQA53$O/!A{[- RETURN TIME:
DATE & TIME REMAINS ARRIVED AT CREMATORY: LAW /S'gow
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
ftA asaeout
NAME: FAJC OrDfl.po 1 I ICASER
TYPE OF CONTAINER: l q lba[ I:e{ - WM aF
PLACE OF DEATH: Is6 &Na=AEF 211 -tJffi
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER
PLACED IN HOLD- to ES AM
PLACED IN REFRIGERATION:
DATE OF CREMATION: Lam/ 9-ins
TIME STARTED: TIME COMPLETED:
PLACED IN RETORT: 7M/ MOVED:
RETORT S IN WHICH REMAINS WERE CREMATED:
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN AS HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE OREMATMIM LOG SHAUL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
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SEWYORK D•wm^e^twasw.
pf Division of p 1GNGF==M=*=.1=5
"" Cemeteries oWesirtini
vowni
Authorization for Cremation and Disposition
TM1U Autlgrza nFarm must Ed complMd end idred prior to aegwn a remains Nor Moroccan.
wk: DIVIS12020 Number. -M
CbmeKry Name: Pine Vixw Cre MN
Addram 21 Quaker Read,Oueenrbury,MY tall PM1OM: (518) 7I54C77
CREMATION 15 AN IRREVERSIBLE AND FINAL PROCESS.
Cremation u caned out ey reading Me remains of the d as and Xm Mnager hoMlrg The mature lea a mmmbn ceemeer whom
tMyaR$ULyecbd+o InWn heMaMXeme. 1M M1eamod bme Mll Inciere and consume mryNlng sacept Xom and InMI,
Wlkn era all Built will Ee an later crematicn.
FdlMting oremadCn.mar uematcry will take reasonable theme;to remove all OI the remain.am hirer mabnal(rein Me marl
chamber butwme minimal dust and residue vnll likely be led behind. TM cremebry wIII..peed.inpaanUl eM bregn mMNI(TT
the remains and the Inciaento and foreign material vnll be domestic of a8 tecNted by law. The aema is remains aril be merMnlmlly
downward info small pleas and plamdmto a restricted cmUircrar um, Cnmabdmmalwgemmllyam"lndndunbim
single fragment is ncognmde as skeletal tine.
OPENINGOFTNECONTAINER
The cmmaery may only Open Me wntal er having the remodeled human mmalm in limited cmumstances, muddy e to mean the
Idenalyof Medea Orb wrome but no maboal is enclosed which mlgMiryureemployees or damage Nle memebry premrN X
human remains am delivered In a mMainer which is not suitable for cremaaarr such as ceremonial or moral cal Me
mmaorven reamre Mat Me rem.me a mows inMa anitame oomamer wrore n.aepm Me reman.. Tmapmiy m.
malnar o,Ma bamfer ar.inert mlenwe wn eemnancmtl baron..wiMan aria will be sane m parecn wiM signed aria reap...
IDENTIFICATION OF DECEASED
Nameof Cemawa Pouf P.Oural MerXal sblue: Maned
Lea known Mdre IN Lnmanm mail Art 211, SamM]a 5pday. NY 12M
Place of O.aM: t W tamema street AS 211.aaeM2a Springs, NY 12M
sex: ID OF Age 92 Dora: 05/27/1928 Dmofine 0611a12020 Eamamwaghe
Descrewon of YmnWw In M11M mmvmxis he bl'nered.
Cardboard Box wNJaaden Base
PERSON IN CONTROL OF DM IMM
(Pmtm(al In cmtmlolg9 , ragp'OMEUMe la'bwug)
soon¢are Me aaelgneUd aaeMOl Me tlBceeeN tleegneUd In a will Orwrmn ineWmeMexml2N pursueMb Pldlk
tkam law season dzo+.
-0F
A611, NAM have he knowledge that Me Novel enuOM a vrtlXch lneWment ryreuard To Iii Neft Lew sec40n 4201 ore
MII converted dreNone be the dbpwdon of his or her remains and INNER art Me deal having Pacer under Pudk keeled law
$ec4m d2pt BN M1eva Ma yMb auMOr¢0 PBmeKn Olm reme�n8 MMB OemesM. MylWr miNonehlp MMa dacnsed Y as
foil wn'
Paul P. Orofno
o05-+e96-f(Rev. Met Real
Authorization for Cremation and Disposition
(Ini M1an me Furl bekn'1
Number; 2 Oacnphm Shaped ONRr0(SpoWe)
1. A"man rental In Aural pmeuam b Pi F M Lew Seton C01(3):
2 The eunmry arouse
2a. The moral channel Ruder,
a My mri cola crossed yeas of"a Or clam
l Asumming parent
6. Asurvrvinl sibling egMeen years of age or char
S. AI deal appointed 0uardian;
T. Mry perform)elenlaed rem ofpee or older er2ned Is Where In the eenb add ono al coal In releban¢Mp to the symbol
S. Aduly social4Aucbry of ma acrossl
3. A di hand or hadarve send has automated Wormed ebbmed assume to Pude Heats Law Second 4201(7),
10u A rArel Fund oMmr of a¢uMy or a punik Assi etrebr apaanssd purmanlblhe 3urnged'a Lan Pmuyure AU;
10a Any other person wed IS acting an Mhaff Cl the deroaed and who has real a wnMn sucament purauand to Firm IsHealth
Law season 4201 O1
yy��(� ALL PARSE arms r oyeal
drill led l byaffirmmaHM[ ofine�mdd0 nWmnbinabatlery, b "pad. p rmiI n]ioeNve implant.
or radrvpc0vedeWce and therany fund melenal¢were mmouM prlorto V4eKWtiOn of AU orhatlon Fond Fallunbremove
Media Mines prior b cmmatlon may drug in ham W Ns crxnal all camel pamwn .
Vi Wp$Man that ln¢Oucnns name Milan eland m Rolland c. Hoeg
Rgerdiry gm removal of any porsonal goal or other thing of MPa%l any coach signing below or any family member More
Measured wl9ws m reveal. Pray all Cmmamry
ie nor temporal for the rural of radial Items Man me consumer or nods 6b Rmens M the tendered Pascal Items "In Me
brie ✓ timer or ram M m the well be dno by M d yed e therms em all memory a memorymemorymur be evM ann alter a0on
NW hamby,aumodae Pre Yow Cmmatu'y
aNam
M smnM Me remains of Me dowsed.
I�CPTIDNAU
LYm hereby authorize Me named maw rat dlreMorSo provide for delivery m and cmmatlon by an ahamN
mmatary,If dmrmd real hyr In Me opinion of the Nnwml Winston and by amend this lorm m provide Me coact name and
address of such of mato aremal
FIXAL OISPOSRIOX
The pram autham ]to ramiva me uemabM awards M the associated Mom MB annual'a:
Name, CcmmitimaM Fumrel Cam
Mideast Its Mapb Am., Santora Sports, M'12M p�. (616)5&J61a
TM(dremeW rMdelns M MmawM art be disposed of as color
HeNm To Fal
If for any"W use Maul mmeM aiwm does out bl s moratorium set Me venial names,
Pine Yaw Cremation, bwmwlaN In give pxmmim0
may nail +nawdu Cmyss FurealDiane,lx by dandy
In Oman or by MyselfineiL tvwweeaw�e Paw R Dart
DOS95girl lRev. 0420) Par 2M3
Authorization for Cremation and Disposition
(i me memands
K✓l li unto m mat it Me remains are not demand w1mm 120 days W aema,
Fare arm cre mamry MR elapse or me remains In
animpevab6 manner.suds as by sr Rnag.
CREMATION CONTAINEWURN
( Ii ONE arms/eMmvlyf
An um to be useE em a WMainer for to aFn mmaina has LBBn storage horn
and is aesQ dit ae wllmn'
INia urABRhne that it the um is ins mall of Mq dons ender=metal mmgms. M ae]Nmal Wo rmlainp may of see V d llm7.
QP.
An Nn 'pnot of purMmed. Vi undwMM Net if no um is Wrtl or otMrw'ee pmvNM
Nor Ywm Cmmebry fall plan the Mm rtmains In
e Mid temporary mmainer far denary. mwmcrwn
This AUNoriaatl Form was povil by aGNM G. XCp wasexaMNA
4m omw FmerY bad,me
402Ill Asia. Saratoga Manner. NY 12M
Malesi dy Ne mnerel dirhtor of mimes mroa.ecu4on
MR,here rewivea a composed mpy or has ArMo on Fomr.
Thepnon(s)Wamiflee bebw lams the pnonµpn wnl W disposition,Mro q Dianirr3 MID AVN efim Form,Rss)
to that aauraay and Mmpwwness or the Infwn len wnmrM In Nw AUNwzaw Fomr and aN Om (S)doe wrpoine.
SI9md Nor 1EN day W June p 2D
examiaM Anal {}tµ� ('
15fi Lem+erip Sbat W211, 3era"a Sphnq, NY 12M (� �
WITNESS'
11Sampvnemvew�r nE�nCb4r4M l /�
Housed G. Haag ((//m 11338
Fed F. om m
DOS-1303-t(FAR DMO) Phall 3