Hanlon, June Pearl Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: (AVLW RETURN TIME: &IC
OATH S TIME REMAINS ARRIVED AT CREMATORY: I/I)(IM Z:w F1
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
NAME: Tol NFNIbt1 CASE R -ML
TYPE OF CONTAINER: /p' rvK{Nyw — �( AMR/I 66M
PLACE OF DEATH: 4 LLNRn.,. She,} I NoR(L. N4U
ESTIMATED WEIGHT OF REMAINS B CONTAINER
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: IeII{ I b
TIME STARTED: 7:04 TIME COMPLETED: �I1Ou:IJ@1
PLACED IN RETORT: _ _ 940M MOVED: T IL !1^pII 9•�A,h
RETORT 4 IN WHICH REMAINS WERE CREMATED: NER Yw rNP
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY: Z
NOTE:THE CREMATION LOO SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
ate
" uthohzation for Cremation and Disposition "�o,11"flimeel
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AIMnY.NV 12231
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This AUM atlon Form must be completedar sig dpd"to Delhi of remains Am cremation.
Date: 06I182020 Number. 71
Crematory Name: Pine View Crematorium
Address Quaker Road Queensbury,NY 12804 Phone:
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremation is canned out by placing the remains of the tlacoased and the container holding the remains into a
cremation chamber where they are subjected to intense heat and flame. The heat and Dame will Incinerate and
consume "anything except bone and metal, which are all that will be left after cremation.
Following cremation, the crematory will take reasonable efforts to remove all of the remains and other material from
the cremation chamber, but some minimal dust and residue will likely be left behind The crematory will separate
incidental and foreign material from the remains and the incidental and foreign material will be disposed of as
requiretl by law. The cremated remains will be mechanically pulverized Into small pieces and placed into a
designated container or um: Crmnated remains generally are pulverized until no single fragment Is
recognizable as skeletal tissue.
OPENING OF C0NTAME0..
The crematory may only open the container holding the un-cremated human remains in limited circumstances, such
as to confirm the identity of the deceased or to ensure that no material is enclosed which might injure employees or
damage crematory property. If human remains are delivered in a container which Is not sulteble for emma on
such as a ceremonial or rentel casket, the crematory will require that the remains be moved into a soluble
container before It accepts the remains. The opening of a container or the transfer or removal of remains will be
conducted before a witness and will be lone in privacy, with dignity and respect.
IDENTIFICATION OF DECEASED
Name of Deceased: lone Pearl Hanon Marital Status: Widowed
Last Known Address: 9 Catherine St., Hudson Falls New York 12839
Pkce of Death: 9 Catherine St. Hudson Falls New York 12839
Sex: M ® Age: 74 DOB. 06/261 Date of Death: Ob/16/2020 Estimated Might: 10016s
Description of caskeVcontamer in which remains will be delivered: Matthews Cremation Case
Plywood bottom) cardboard top
PERSON IN CONTROL OF DISPOSITION
(Person(s) In control Of disposdion, intlief ONE of the folbwing)
I am?We are the designated agent ofihe deceased designated in a will or written instrument executed
pursuant to Public Health Law section 4201.
-OR-
lMe have no knowledge that the deceased executed a written instrument pursuant to Public Health Law
section 4201 or a will containing directions for the disposition of his or her remains and (continued nextpans)
June Pearl Hanlon
DOS I 641(i Dvm) Na'ne aoemaw vase 10s
I ant we are the person(s) having priority under Public Health Lew section 4201 and have the right to authorize
cremation of the remains of the deceased. My/Our relationship to the depressed is as folio":
(Insert from the list wow)
Number T Description. Grandhaughter
1. A person designated in writing pursuant to Public Health Law section 4201(3):
3. The surviving spouse:
L. The surviving domestic partner;
3. Any surviving child eighteen years of age or older,
4. A surviving parent;
6. A surviving sibling eighteen years of age or older;
6. A lawfully appointed guardian;
7. Any Parsons) eighteen years of age or older entitled to share in the estate and who iVare closest in
relationship to the deceased:
a. A duly appointed fidudary of the estate;
9. A close Mend or Zell who has executed a written statement pursuant to Public Health Law §42o1(T},
10. A chief Most officer of a county or a pudic administrator appointed pursuant to the Sunogate's Court
Procedure Act,
10a. Any other person who is acting on behalf of the deceased and who has executed a writer; statement
pursuant to Public Health Law "201(7)
(Int I ALL THREE of the
D IANe hereby shim that the body of the depressed does not contain a battery, battery pack, power call,
radioactive Implant, or radioactive device and Mal any such matenals were removed prior to the execution of this
Authorization Fo0n. Failure to remove Ness items prior to cremation may result In harm to the crematory and
c^re11matory personnel.
IAhM hereby affirm that instructions have been given to Inv.lwavao..ami Cassandra S. Maille
regarding the removal of any personal property or other thing of value which any parson signing below or any family
member of the deceased wishes to preserve, rmnnnvy exe) Pine View Crematorium is rim
responsible for removal of personal items from the container or from the remains of the deceased Personal items
left in the container or with the remains will tb destroyed by the cremation process and cannot be retrieved
after cremation.
alMe hereby authorize rmmnmxosmq Pine View Crematorium to cremate the
remains of the deceased.
FINAL DISPOSITION
The person auNonzed to receive the cremated remains of the deceased from the crematory ia:
Name: Contemn Funeral Home Inc
Moral 68 Main Speed Hudson Fella W412839 Phone: 518-747.4243
The cremated remains of deceased will be disposed alas Misuse:
g£idc.I N Fkn3w
If for any reason the person named above does not take pmees on of the cremated remains,
Immemn,�emq Pine View Channel is authorized to give possession of the remains to
roms„i�m,,,,,wmp Carleton Funeral Home, Inc. by delivery in person or by registered mail,
June Pearl Hal
oos.ta9e.r.l(ea..crap) Neva eDevex as ; 2w3
(Itael the T011oweig
pn)ya i lMe understand that if the remains are net claimed within 120 days of cremation,
ww""DW,um l Pine View Crematorium may dispose of the remains in an irretrievable manner,
such as by scattering.
CREMATION CONTAINERNRN
(Inlfiel ONE of the Mllowing)
An um to be used as a mntairrer for the cremated remains has been purchased from
Carlson Funeral Home Inc.. and is described as follows:
lMe understand that B the urn is too small to hob the entire cremated remains, an additional rigid container may be
used for delivery.
-OR-
An um has not yet been purehamed. We understand that if no um is purchased or otherwise provided
rmmmlwx w,ml Cassandra S. Maille will place the cremated remains in a rigid temporary
Container for delivery.
The Authorization Form was provided by (ewm ownfov come Cassandra S. Mehra
was executed at aawauww waa) Carleton Funeral Home Inc.
Ilvrenl ham.addwx 68 Mein Sumn- Hudson Falls NY 12839 and is signed by the funeral director
as witness to its execution.
lMe have renewed a completed copy of this Authorization Form.
The person(s) Identified below those the Ferments) in control of disposition, who by signing this
Authorization Form, attest(s) W the accuracy and completeness of the Information contained in this
Authorization Form and authorize(s) the foregoing.
Signed this 18 day of line , 20 20
Dance Hanlon
1491 wawoNma.
Saratoga Rd Building 1 Apt 123 Ballston Spa,NY 12020
Address
TlwewvmradNam. ssm.we
Andreas
rygew Rimetl Name Spnwa
Address
WITNESS:
Cassandra S. Meille
FunewY DbxA•TpftlwPMIM fM'ne FtvaM Wxlwa¢r.M1.n
14257
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June Pearl Hanon
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