Dowd, Helen Rose Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4478
FUNERAL HOME: __ _ ___ AK 11jvy)'W, RETURN TIME: p�
DATE & TIME REMAINS ARRIVED AT CREMAYORY: LIMIT )'Oa rrl
NAME OF FUNERAL DIRECTOR OR REGRISTEREO RESIDENT DELIVERING REMAINS:
PAIk AKVW
NAME: jluL o ARID CAME R 12Y
TYPE OF CONTAINER: N. I yi-c,ur
PLACE OF DEATH: t? AADVIIY 54AJ61C IfRAINt(A LL gin
ESTIMATED WEIGHT OF REMAINS 6 CONTAINER b JIBE
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: G)II)]O
TIME STARTED: 2:WM TIME COMPLETED: /13•10M
PLACED IN RETORT: I'IDIYI MOVED:
RETORT R IN WHICH REMAINS WERE CREMATED:
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN AS HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE THE CREMATION LOD SHALL BE RETAINER IN THE PERMANENT FILE OF THE CREMATORY.
1
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SIAT of K pIVI510Il Of Mpe msrro
SATE Of OMSION OFCEMETERin
OpPoRiONITC Cemeteries o r pa
99day asnNY 122Pvewe
Thep ne I518071,6126
Authorization for Cremation and Disposition
This Autb iftaion Fisher must ha complated and signed prior to delivery or remains Sir cremation.
Data W1112020 Number: 7Ly
Cmmamry Name: Pine Yew Crainestory
Adbess: 21 Quaker Rd. QUarderni NY 128N Phone: '1
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremalim 's remM M by placing the remains of eettu0tl ant the taxpayer lol the remains into a cmrnal chamber Mere
they are sugOGetl to Intense heal and flame. The Mal ant Barrel embedded and consume everything except bone and metal,
whim are all Ma will M lea a Mr conceded.
Falbwm9 cremabon, Me crematory will take ressambe eirons ro remove all tattersall and other material from the cremation
chamber, but some minimal dust ant residua ll likely be IS behind, The cremaoy will separate Mcidentel and mmgn maMlel from
Me remains and N ,losdenlal and foreign material will be panel dies Norman by lBw. The cremated remains eel be mechaniWly
Wlvedssd Imo amafl pieces and plawtl into a designated ¢nbiner or um. Cmrutetl remain gamrslly are pules ved unUi na
single fragment In recogniaeble as skeMal Vague.
OPENING OF THE CONTAINER
The p¢mMdry may only open the container holding the ur cremated human smarten limited arcumstanteg such as R confirm the
human
deor toencore 1Mtinmehriwhic iserchsuit MiCM1rma ina employes orerawal orcrematoryd,the II
CM" remains ere tl that they
In a container moved
into
non sui
table consul
aonm it accepts
pts Me re or s.panel rdenv the
rMtery MIerequM that r coo remains ere Mil b icon a conducted
b f rea witness
sabre a a e don Me remains. TO niiy and olB
wMainera td¢trOne(ar or removal W remaim will be coMU[hd [snore a witness and will be done In pdvecy,whM1 dignify and reaped.
Name or Deceaand Helen Rose Dowd Manned Slmus: WCOwed
tasl Known Address 2 SCtool Street, Lake George, NY 12W
Platy of Death NY li<)Z N OadtYU ftp;fn Cra 4wk
sea: OM ®F age: 86 Doe: 11/W11925 Dme MDeOM, 06/1W020 Ebmatm weight��
Desorption of w.kevcomains in which remains will be ceuvered.
New England Cremation deluxe container
PERSON IN CONTROL OF DISPOSITION
(Persm(s11n xnlM o/dsp¢adnn, �ONE o/Hre IdbwSiy
I met are Me demanded outsmarted dettase l designated Ina will ormaren deVumed assumed pursuant le Public
Heelm Max Sectsun 42PI
OR
IM1Ye have
no knoWe ge Mat Ionm deaeM isio execurld a vn dwanament Wrauant to Public Health Law Section 4201 or a
wit w nUmiy mretliona Id Me demanded M his or her remains and IM2 are the cession(s)having primN under Puma H®uh Law
9ectlon 4201 and have me right to amodu cremation of the remains M Me ductal MyOur Mia Ship by the Macerated Isr
achieve
Helen Rose Dowd
DOS 18984(Rev, 06120) Pagel of
' Authorization for Cremation and Disposition
(Inclut more the our deal
Number: 3 Deschprev, Sunn irw Child
1. A Ponun oesimal in uMing pursuant to Public Heats I Sasser 1($,
2. Tde arriving spoon:
as. The survival demand Islamic
S. Any surviving cam elgMnn years of we or aides',
0. Awnlent peace
5. A wrvinrp iehry wareen year Nape Or older
S. Alu led appointed MeaNiw
L Any perform)eighteen years of we or older elected M sham in the estM and who lyere concern Radio 1p to the Mora :
S. A duty appointed fiduciary of the estatei
9. A dose hard or relative who fees m)dOmd 8 wNen fbtement pursuant W Public Health Lew SerlioM2o1(T)I
10. A deiNfisml officer M a county or a public administrator appointed pursuant ad Me Suncgate a Card Procedure Am,
that. Piny other ce9on who ie acing on dualf M the deuaW and who has pwddwd a written fetement pursuant to Public Heahh
Lee edition 4201(7).
Real THREE of Pay, w Wroing)
Zr,
Inve hereby afmm that the Body of the aenand aoelf road murder oanery, banery panes, power can, raeioacer: implant.
or emotions choir and 0at any such materiels were r¢mond prier to the Header,of this AUMmiaatlen Form. Felturo ro rermve
these Items Prior to cnmaaon cry result in harm b Mu cnmabry and crematory wMonnel.
�_uwe eMrm ten ease tiorf ran xer givann %� „t� f}/e��� '.
Persons the removal N any pereonn property or Miler Mirg of van¢whim any pension mignry Below or am femlymemberof the
exesud wishes to pmnrie. Pine View Crematory
is not responded er Me Phil of penonaueme horn the demand or Me remains NMe deduced. Paaominemaknm Ma
container err Me remains will W destroyed by the cmation pmwef and unmt bid mdbW after memNlon.
awe hereby aumoma Pine View Crematory
needed,"i
to demand me remnm ar the domes .
(tenet DPnwvay
tMa he Wy enhance the named fumral i irectorb provide Air derrvelry to and cremation by an alernae
unatd ac ry, if deemed n «sary In the opinion M M w teN of naml director, and to)me M form Samuel me coned name and
co
N such alternate cannel
FINAL DISPOSITION
The person authcdnd to r¢eive the cremated remains of For dedafed from the Damatpy if:
Name:Alexander-Baker Funeral Home
undress'. W09 Main Street, Warran9buril, NV 12885 Phone: (518)623-2065
The cremated remains Ndeceued will the disposed of as Ali
curial in Evergreen Cemetery
1f marry reason"person named shave does not take possession of the ue tO Retains.
Pine View Crematory a amhooud to give possession of
Me became to Alexaader-Baker Funeral Home OR deilvery
Futixam xm4
in parson or by mgisfeml mail. Helen Rase Dowd
DOG-099&f(Rev 041 Pale2 03
Authorization for Cremation and Disposition
llndmr 'npl
a umawna mat of the remains am not amimed wimin +zg mysdmmMion.
Pine View Crematory may disease or the remains in
an lrreenebk manner, such as by scattering,w
CREMATION CONTA NEM M
inda ONE dtlre rdbwsob
Alexander-Baker Funeral
An um W be used es a contains for the canceled remains hss been purchased from u.....e
and is Mounted as holders: Mint"I ie Um Vi
Aft understand mho it Me um is too smut W had me entire demised remains, an"rental rigid Convener may be used for delivery.
-OR-
MumisndyMWrchawd. lM/euMmtandmatitnoummNra oraemwpmNdW
Pine View Crematory wul piece me cremated mmains'n
Mani
a rigid tempdery container far deirery.
Ties ArMotiona n Farm was provided by Was ewcNed at
Alexander-Baker Funeral Home
3909 Main Basel Warrensburg NV 12885
and a vaned by me Anal chador as vntmes W he exewoon. W
IM14a taw reasowl a compiMed copy of this AuVroriaut Form.
The peadr191 WMfled below Ware the parwnlai In contrd Of dlspoil .who by signing this ANh zatl Farm. ataMlsi
W to accuracy and compensates or the information wMained in thb AUr riZaon Form and authorizslQtM toregolna.
Signed mis 11th day June ,20
Christine Molella �a�NAe I ' V.M.�y+Ffi
2 3cM1ool Street, Lake Deorge NV 12945
Anni
rmad w� so+w
WMNEn �1
r HILVNN}eC/
p
Ob y
Haden Rose Dona
008.18981. O4120) t�w�o PaggI