Richter, Taisto Pine View Cemetery & Crematorium
Quaker Road
Queensbury: NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: S_5_e RETURN TIME:
DATE & TIME REMAINS ARRIVED AT CREMATORY: M(M g.MP 2 'R{11
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
4 JIM voa�
NAME: _ TATI O fui(TC'P CASES 77Z
TYPE OF CONTAINER: 6996
PLACE OF DEATH: SEsof
ESTIMATED WEIGHT OF REMAINS B CONTAINER 156 ly
PLACED IN HOLD: ,
PLACED IN REFRIGERATION: 2.6(�f�A,1 I
DATE OF CREMATION: _ Ip III IS
TIME STARTED: -):LAM TIMM COMPLETED: 1 'i'fVl
PLACED IN RETORT; T 4061 MOVED: 1:7F AY'I T O)kM I,-q7
RETORT # IN WHICH REMAINS WERE CREMATED: SUPER P y_ CAE
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.
1 -
New Your
NE' Division of wwMnantwlMES
STATE Or OMSpN OF CEMETEME4
OPPORTUNITY Cemeteries w=,�^me,ce..us
M Pen Gvenve
Talent,... VaIdDil
Authorization for Crematlon and Disposition
This Aug "W Form must be mmrrimed and sine prior W dellven of remains for tr Lion.
Date: 0610912020 Number: 727
Oremall Name:Pine View Crematory
Address Quaker Road Queensbury NY 1213M plow. (518) 7di
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremation la owed out by plaung the wool Of the deceawd and Me condur er ndeing the remains imp a p ma0an chamberwlKKO
tryaresuNer bintenseheatandflame. The hog and Rsrm MII incinerate and comums wa ing except bane and oral.
which am all Dart MII be MR them ce fion.
Following crenadon.Me channel we take reeWMble ghoM b remove all of Me remains and hear mall hpn be bananas
chamber but some minimal duet aid residue MII likely be Ind behind. The Gamalon will sepSM Incidenbl and Mo ign notarial from
merema,Msod Meinmendlane MNgnmatenal Mnbedl5(Wofesreaolredbyone The aemalee remains will be me nimlry
Pleasant inb small pleas and placesIal a Prepebtl mn4inw or um. Cmn mnsinsgonamllysrepulvee umm
single Ingment a rscoMmable am smistal Nnw.
OPEN NO OF THE COX MNU
The hall may cry open the container holding Me unCRmtlad human remains in limited circumstances, such as to confirm the
identity ofthe managed or to ensure thin no menorahs endoxtl which might lnrym emoloyeei or damage the crematory pgerly h
human remains am delivered In a contalmr which Is not suXable for emmatl Such As monlal or rental Gab4 ere
u at"MII raguire Met the remelm b moved Iran a Suitable consul before it sccepb the remains. The opening of
consumer or the tranahr or removal of rema'Im MII be conducted before a wMess and MII the done In power with equal and 25px1
IDMnMCATON OF OECEASEO
Name of Dammed. Taigod Richter Mattel Sal Divorced!
Lest Nppwp t s 29 Sunset Drive. Queensbury. NY 12804
plena aC ffi.. 29 Sunset Drive, Quaensbury. NY 12804
Sea: ® M 0 F ape: 79 Other 0W0711941 Der W War, NIOW2020 Estimated Weght 1501ts;
Omn om awWUm WN in which lemsins wil betlefiwred.
Bul to Casket Company- Alt container
PERSON IN CONTROL OF DISPOSIOOX
(Paraonpl N mole debarkation, full ONE dtlre hWwipl
I arn'i are Meengnatee agent dine eS ddeel W in a MII orwean instrument eximmuslWseism b Public
XeaM Use Betlbn 4201.
IM1Ne eve no knowledge that the deceased discussed a trader inebument pursuant to Public HmXh Isw Sweden 4201 a e
wn ning Simmons;for for M disIcauden W his or her namelm and hale are Me tcRon(a)having pnorm,under Public HmXh Lawn 4201 and have Me Ogles to euMOdtt Cremelion O(tlb remtine dine demesee. WMUr n anhlp W tin Wcrossd Y as
Ediw
Taisto Richter
MS1898 f(Rev. 0420) Pam I d 3
f
Authonutlon for Cremation and Disposition
(In»rt firm the FN Cebw)
Number 3 oearipuon'. ClaW over the aae of 18
1. A person designated in waiting pureuanl m PoNic MMM Len U Seon 4201hu
2. The Sui spouse',
29. The surviving dome8f pnrrt[
3. My surviving tied eighteen veers of age Or oM ,,
l Asurviiving parent,
6. A surfing siting eighteen years of age Of deer:
8. A Walter appeared guardian
T. My perimesl egMeen years of ape of outer enured to share In the estate and who ishave desert In mmeomhip m Me exeaw]:
B. A thi"Ppointed rpuoery of Me mass,
S. A them frend or relatbe who has exeated a wNbn Matemenl pursuant m Public Healh taw SeNoM201(7),
V). A chM i oRwr W a aunty a a publlC administrator apppMW pureuenl m Me Sumgate's Coun PrcpdUre Mc
1M. My Other parson who l8 tiding on beat of the deya9ed aM who has exeaKd a"FunetelOnNM Wreuar to Pubm Heats
taw Section 4201(71.
ILL THREE oflhe mlmWng)
IfNe henby aMmm that Me body Mate attmttE does Mt wMain a Ntlery, Mt@ry,pace,pvnar mil, MiOBgrve irtgYant
a mal egim device and that any wN mMnale were reseed germ Pe petition of the Aueweneon Form. Failure to nmme
Mw Meru prior m cremetlrn may mult in ham mlM cmmemry aM crmumry perwnrel
affirm Thn'nmucaom hew been gwen m Mark JJDeS�imone
vr.
regarding the remmal M any peneaul pry my or earn thing of wade whkh any person signing beiw or any ferry member of Me
deceased wishes to maeaee. _ Pines View Crematory
rw i
rs not rtspensibk lea the remmal of penmel tieme M1om MB wmelnNor hem Me renainaMMe tlemased, panontl Mw bh lnlM
(�OMAN/t„n.rg)wnn m.rehalnewell t»ee.beyae by Mn rremmw precis tine penny a raMmaa afar cremation.
/yLU1JNh henby,aumreu Pine View Crematory
U rn."`r mmr.m.mtn.nm.m.orrna aecaavad.
II�wI DPTIONK)
Its heady aresseu 1M namW mnanl elRtiwto pamor, fa aeMery t anti form
to iro id an ellemale
.nnemry, x aeemee neceuary in Me opinion Nmewnanl elractor..M m.meM this mrm to pnwiee macrnect name and
eerea OF almmro Cnmamry.
nHAL DisP0.5moH
The Par en amhaivedto receive the aemaWe mnalm or the de to esm ran nA aenutay ie
Name:Mia Richter
Address 29 Sunset Drive, Oueensbury, NV 12804 phan. (518)280.2367
The cremated remain W denamd 01 W dew]d a Mdwe:
Returned W the family
Inflow eM mmonthe Ammon sense aWw domes red hem poem w adds nemabd nominated,
Pima Viaw Crematory a emhaine to pin lanenim of
Menhaimm Singlemn Sullivan Poeer Funeral Home Mdemry
in pawn dry repkka.e hall. TalsW Richer
Oo8-ligi Nov.Me) Ppe 2 0 3
Authorization for Cremation and Disposition
' Ito Mbwirg)
e unMNaM Mal tltlre remain are mt mari whin 12o tl m or cremalmn,
Pine Yrew Colossi may demands of has remiss in
wa wCmwew
an In manda[b mentor, suld as by BGlbntp.
CREIMTION CONTA NE"RN
Nprsal CdVE of Me blbwirq)
Singleton Sullivan Potter
M um to his use as a container for Na vemNed RmNne has Man puMased ham c
and is devotional as folklore;
Me YMenbnd uvl Mun um taro small held Ito share cleared remand an saideaai No warmer many M YW Mdermy.
-OF-
M led is not MpYLmeed. IMM YMa9bM Mat R no um WrcM1UM or observed paYNM
Pine Vlaw Cremai ve pyre the cement mnalM In
Ir.messiah
sped bnywery mentally,fordefivery.
The AYmoma Form wr provided Mark J. NSimone was ea«uya at
Assamemi
Singleton Sullivan Potter Funeral Home
407 Bay Road, Dueensbury, NY 12R04
add is sign by Me headed airedw as wuneld m its execution.
IMb ham mwwM a Composed may of this AufFmeeaon Form.
The pandi Identified many Islam the elements)InControl or dispasbon, wM by N9nln9 Nita AUMarlaeeon Farm,lowest
b Me sacunay aM ComplNaness of the lnbmWon contained In this AYMor'ialb and suMwlee(s)Ms forspoLq.
&pnsd MN gad day of Juno 20
Mia Rich ter
29 Sunset Drhre, DueensDury, NY 12R04-
x�
.w.esa.wrx.,. dew..
MaIk J. DeSimone
m++mmmv.awe �cw w 10919
Taisto RicM1ter
Iai se
DOS-159e4)Rev. W20) Plate 3M3