Harrison, Karen A. Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: IMM?EssLOYm RETURN I TIME: //SS��
DATE 8 TIME REMAINS ARRIVED AT CREMATORY: b III ) k1 2;%M
NAME OF FUNERAL DIRECTOR OR REGRISTEREO RESIDENT DELIVERING REMAINS:
P+RI& 806ne"
NAME: KBPDN McRT,90 CASER 7LS
TYPE OF CONTAINER: l IIM.,d (Ea — ON(..
PLACE OF DEATH: IT thay D¢suf lAtAw" afts r MJ IT
ESTIMATED WEIGHT OF REMAINS E CONTAINER 36D / 3d5 (Xf
PLACED IN HOLD: aA`PI/1n
PLACED IN REFRIGERATION: 1
DATE OF CREMATION: U IN lip
TIME STARTED: -)I O eon TIME COMPLETED: IO wArl
)1
PLACED IN RETORT: IDRTI MOVED: : to If. LID • 11 /04IF I
RETORT A IN WHICH REMAINS WERE CREMATED: K
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE,THE CREMATION LOG SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
Now
WrsbW
— NEW FOEROORK Division of ^MMIOII�Oneirtgnmro MB
Cemeteries 99
ew.vowhismon where
here
TeaaN =tMh4 aTaa
Authorization for Cremation and Disposition
This AUWONWon Form must be complmd and¢Tenn pricrA delivery of mmalns Air nvmtllon.
Da: 061101 Nuntef 71S
Chamber beer Name. Pim Cremalay
Addrawn II OWMer Road.OmanMury,W II Phone: (518) 7454478
CREMATION IS AN IRREV RSIOU AND FINAL PROCESS.
CremAcn is umetl ON by plong be remains of Na coatings and Me mM w vxm My remains into a a Von¢Mmbx whom
Mary are outlined to intense Beat and name. The Mat and Mae will Imml and consume eve ing eeeep:Wine and mend,
which am all Mrs will In left after cmmauon.
Follow,ng them thin.to aemabry vall nits reasonable many b remove an Of be remains and oMBr mammal M1om Me common
chamber bin game munbal duel and residue All likely be W Whom. The mm iwil aepetem MWenla are foreign Mamal M1mn
Meremain¢alp Me InGdemIDaMbmgnmaknal MuWd'cepmBd OfnrmulMbyuw. TnethenaledmmaiMwilbem mmil
pulverized,m small Palms and placed into a marginal memories or um. Cmm nowns perwnlly Am PuNerhad WAS no
single fragment mmpArable as wedged magus.
OPENING OF THIS CONTAINER
The cremalwy may Only union Me cone ner holding the unmoral human rwnaina In Inked orcumstmonal such v b wnfilm Me
gentTy OI hive de[Geel or b enwm Mat no medal la endns M uTIN mgM Injure emplaym¢Or mamege Ma rmmalwy pm�dy. If
human mmaina am delivered In a container which Is not sunabg for monarch such a¢general or meal u¢M4 Ma
crametry will require gel Me nermim W moved MM a suitable coming whom of farmed Me mnalns. T ommirgofa
of ,neror Mehans%rorre oO tl mnamwillweanduclem W( ae msendwillMdom lnpmaW x dgndyamreagct
DENTIFKATION OF DECEASED
Name Ol Delaware WIMANYdeon Mantel Sable: nwMd
Last Nnmm Anneal: a XtlN Dried.Shamir Spire¢. NY 128P8
Flaad Dean: 12 golly Ome, SYamw Splrea, NY 12M
sax: DM IMF roe: 73 DOB 03/29/1947 Da of DaaM: MJM020 Enmst 9M. q6f)
Da¢niscn oft sWV itee re in Mich aFe"A M"h
Cardboard Box whVooden Bade
PEM�IN CONTROIL OF mON
ri'awnre)NmnIMAdIRmwLm, aszaaoNEaM.ramwMm
amMN.m Me amymrel egemorMa OewaW mHIgnAM in a with orwl8bn ln¢Wmmt exeab]PIKWam N Public
mo r Law Serbon 4301.
lAgo have he knowledge Mat to deceaeal execute a w segment Punuem m Public man Law moon 4201 or
ran dmlrgdllx9 se "d,sawOfhm«hermmag¢aMuw mMe Mmw(s)hwingpnoRyuMer Publpt MLM
n a3of and have Me rim to aumoms CMM8w Of Ma Maine of Me deceaeel. Seypur mlauommp mtlw deceased Ism
mId
Karen A. Harrison
Ductal(Rev Dari(i) Page I of
Authorization for Cremation and Disposition
(assurance the lee being)
Number 3 Assurance Juleam fredom([mul
1. A armarn designated in voting wmuem M Pri Heats law 50c'iYwt 421I
2. They suwivmg¢pome.
a. me aunlNng Oomnnc mr0ter'.
I. Any accent;chip eghmen yaam of age Or Nobel
4. Asurvivlrg pamrR
6. AwrvMrg sl0ling eighteen years of age a beer
S. A gravel near trades
i My pearmle eighteen"am of age or Order end%yd to stem in the state and who iarare cbsesl In mblioMhip b HebewYeb:
e. A buy spool need Harris"the estate.
S. A dose Mend of relative win has secured 8 wines shR Wr¢uenl b Public Health Law Sedon 4201(7).
10. A brief Hard ottisr of a county or a public administrator appeal pursuant b the 6urrcgffi'a CWrl Pmmum Aet
10e. Any other person who is icung M behats of the deceased and win has executed a written Yemeni pumuard W publle Heats
Law decade 4201(m
t 1go of Me Mdowteel
NNe hereby athim NN Me busy of the symbol does nut cormM a battery.battery paU, power call, 2 iwO"arralAeni
mbleadlve device and MM any such Wasnals seem sooner per to the aviation of am Ar oratl Form. F¢Ilum m cocoon
I s ee Her to cmmmon m ham so may u tt l n ha0e modest
and mry pemomel.
Idea ahem blot ln&rvC0ore have been given W Ha11and G. Hop
Nang Ma removal of any pawn&pmleM a other thing of dome which may person signal uslva awry family rrM NNa
dereasM assume W Annual. PNBV Cameroon,
is not moderate father Rmwel of seasonal farm from the mMaMer more MY remains Otte Mohamed NmnalX slMinhi
w oil MlM orema1mw111bd oyedbyN emmadonprO andwnnMb MMevedabrmmation.
a Mnby auMoi Pineym Cmatay
rxum Wm mMe wmalm ate deC ow.
Nw moreby aulbalae the named cam al bwctor W provide Me delivery W aM cMnegon Noy an alamab
ary, ddeemed necessary In Me add Ion of tin mmmi dhaMr,and W amend MIS Wm W provide its wo tname cob
addmWteav a such tlWmaW mmaWrv.
Fi A DIs BO61TION
The Oregon utlwnaed W mwlw Me uemated remains of this akaeead flan We aemmq e'.
Name: Cdnpmcab Omelet Care
AMmw: 02 MI Ave,Sarmags Springs, NY 12� prom; (51didd,dde
The mme measure Of as will be dl¢poMd a as Mloea.
RC T CamiL i
Itch u any memo day n
person ine above dI namis possemldn Of He a camaMs.
she Nw cremaWry McWMrlmd be parem on Of
Assay"i
MemmmmM CGnpmslomb Pumotl cM. lrc by MlMry,
"or
in Or ter momoderatemate rvva NBmn A. Haman
WS10gb1 prep+n behalf mwu Pagazi
Authorization for Cremation and Disposition
( blbwmp)
IM1W un4embnC Nallltl'n remains are rM WImrtE xiNln iMEeyn cicremeEon,
vlrw Ww crmngary
bay goal ands owners in
a ImNawek manner.suM as by sa nny. m
CREMATION CONTMNEW M
OplpE'ONE&Me betwbp)
M um bM uM Coe a WnbIRr M NB ol&nab0 rw ww Me Seen WrghboE from
and is descrLM by fiat
INh undeTa hot T be um a fto sense b held Me andre aemgN Amaine, an additional rapid mnralmr nay Wu lbr delivry.
O
M urn IB red red puMB IMO understand that it no um is Wr<hBMd Or oMmvmegoMe]
Plm Nave Crematory .and pax tMaemebd mensum in
a ryE M1mparery container for delivery Rvemommm
1-him AuMonzi form was providel by Poland G. Hong IBC BaBMWq
conpa9eknau remove Care.Inc m
Ind Maps Ads Sarabpa Sinew, NY 13096
and IS signed by the runway dla as wiNxe tO 0becuhcn rr IMb have revived a Cempbted Copy Of MIS AUMomatlon fomr.
TIa pareonp)IdenNW belax Isla re Me Mmn(s)In COnWI Of dapmMm,who by signing MW Auffi 4atl Fig .a gs)
W No amu may and completeness of Me lMomadon commonad In MIS AUM Yglm Fm o and aNM (s)rlsa Ma(o ft.
Signed Sony Icon day Jima
Juliann Henson
Avno�x
7 an /a
wwre
W1TNF38:
MOIIaM G.�Hop�
w inex
IfyBnA Xudcn
r/rrmoaanp
[Kell !(Rev. 0420) Fpe9d3