Brown, Joyce Ann Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (510) 745-4476
FUNERAL HOME: M5 K'LLRW RETURN TIME:
DATE S TIME REMAINS ARRIVED AT CREMATORY: w1gi To 30afi
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
_ . 'NOD KU,ME2
NAME: pv . 'PROW / CASE R �
TYPE OF CONTAINER: / Flw y GrYId r9 n)r NV011,Y4 oyl& +-
PLACE OF DEATH: bly F[f(1 MyFIFA
ESTIMATED WEIGHT OF REMAINS & CONTAINERI 7O 4y
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: LIS
TIME STARTED: 1:3r I TIME COMPLETED: LO:IS AHE
PLACED IN RETORT: -TIIf��MOVED;
RETORT A IN WHICH REMAINS WERE CREMATED: f!I O FAPY
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 45 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SNUL BE RETUNED IN ME PERMANENT FILE OF THE CREMATORY.
DaparrNmoni NSleG
SEWYORK Division Of DIvsIOOF on,ceramics,
sus
°" "'TM Cemeteries Dn.< mm
All NY 122bl Cool
THeWfne shy4s a7a
werYdoll
Authoriution for Cremation and Disposition
This AU o/h Form must gray complMe and signed prior to ONlwry or remains for cndremon.
Oat:Jne 17, MO NW r 115�
Crem eery Name. Plre New Cn mq
210uaker Road Oueemere. NY 12844 pp 516745A417
CRENGTIM IS AN IRREVERSIBLE AM FINAL PN°CEM.
Cremation is burned our by places Me mnaine Of the deceetN and the container M1OIEIng the remains Into a damson shamed,winos
they are suOlaMo 10 in4nce handed Blame. The heat and swill lminei and comunaaWryNlrrg exams GOM and Am,
whichawaudret MilgrayInsaR cremwon.
Fotiowirg Norma the crematory"It tine uncommnl+enem to mmi all of the mrsal Sed inner matinal they Me menahon
chamber but some minimal duet and ememe will likely re had Gamin. Theaemetrywilloared In=eMll +ndta nmatnal"m
Me remains and Oelnridemaland broad malenal will grediepoasd 0la8 resulted by lad. TM uematd rem+ins Mil Ee mechenicYry
pulremdmin small pass and peas into a designated a iMrerum. CmmatdmminsgammilyampulaaydYdur ino
slnea wemayldN rewpnlublay...bIMI uaa.
OPEN ND OF THE CONTAINER
This crematry may Only soon Me consider holding the,unoma human remins In limited ciwmelenay such as to WnSrm the
identity ofthe MANAmd or m emum Mtra maenal is seemed!whim maht Mere employees or damage the aemMon prW+m IF
human reme ns a.deltsred Ina conalnerwhlm U not aulable Nor cmmaaon such as amnonm or nnm ca4L the
et u rY will mulm tlu mne, ains BY moved Into a suitable contain,bal itmambars m anilns. Trammel
of a
consumer ortlwtramror or AmWal of royal conduMd bins a wtinees and Will to done in prk+i with dignityand small
DeNTFICATI°N OF DECEASED
Name of ssal: Joyce MO Brown taMl sate: VaWsm]
tnn Known OAdre s. 198 BluebiN ROW, South Ghns FWIs, NY 12003
pa®of MM: al Fab HoagYl,Game Fall.NY IMI
sm ON OF Age. 82 DOB. 11/30/1937 see w Beam.osi E min NNba 7U
DWunt on M askeVaMaeer in whim remains inn be delive
Florence Casket Co. minimum cremation casket (plywDod cormgated cardboard)
PERSON IN CONTROL OF DISP MN
(Panm(s)m ONE Mine b w
I vnMb are may designated agmlt dtlw de® d gmad in a will or comic Imuumant eacutd purwMt NO I'Me
NmM Lax secdM 4201.
-OR.
Ni1 led MWnokrgwkygenlatthedM Weveumdovmhen inmumenspursuant Public Health IAwsection/201 Ora
will anaimng diRG58m for To diaaAbn of h18 or her remains and Ins we the arsenal dying pnOMYumer Pugt I Mled
sec0on 4201 and havatln riirate memmucremadon oltlw reaine Mthe ds 5W. NylOur nauomMp mina bcased IBM
roI -
Joyce Ann Brown
o0S109iRoss. WrzOt Page t of 3
Authorization for Cfsmadon and Dispoaidon
Nurnbr nmauaeascro
rvanper� OwcnPuon: AnveuMvine mlm elgnteee Perry deal«away
1. A parson eaaigraled In whigg pursuamto Public Frafth SBCIWn N20112):
2 me aur"I specs:
L. me WNIMNa soc partner;
9. My SUNIAq chip eighteen years of ape On ilex;
<. AsuMaNp parer[
S. A survlbng ablirg eighteen years of she or deer;
a. A bwWMy approved Mailan;
L Any pereinls)&ghteen years M age or bear enwled W remain Me estate and wM Is closet In Misstate to Ve descam $
S. A duly apMini fi]unary or the slate:
9. A does mend or m yd1e who has emcukd a rninen a manl Pursusl In Public IeaM taw Seetl«d 4211(MY
10. Achief hswl officer of a munryor a public edminlstrtlor abbented pursuant to Me SO Whom Court PMCEIM
1W. My otlNr resrecn who is acting M Moral of Me eemased and who has enwted a wean sMb OM mrstmet W Public Hear
Lax goo men 4201(7).
digg�ilauuA��LL R REE once fMbwnq)
INJa Mreb/BMW Nalme M]yofMe women d dos nMocnwer a M1ery babry pack, powxrmn, rediriesel Wall
or Maeioavtive delta and that any such mati were removed Prix W Me seaM1on of has AUMorhe Form. Ft W MMVQ
theme Ibms Older to cmaUOn may resu0 In him W Me cn Wry and crentabry personnel.
Wll INJa affirm Metiswcticns have teen d"n W Third G.el stew r l
regl Ms removed of any personal prcpaM or ocher Ming of adds Mph any person siyll below or any fanity member M MB
deraeamd whal to preserve. PdnB Vlcw Crematory
is not MeecMibq for MS Mmonl W Wp Rulers from lM wmeetwor fron the remain$Otte dewesad. PamwliwmsiMin"
conwdmrarwNlr lM remains will be destroyed bythe cremadan peewee and cannot be Mlleae Marcmma0on.
IMY hereby aarthi one Visas cmmmo
W aremaw Ma remains are aee.wee.
(LnIL OPPONny
li hereby auuoew the named funeret director W Mri far delivery W and rnma0on by an aIMMM
g, N doomed necessary In Me opwm d of Me fu xl director and W.mane MW farm to Provide Me correct name a nor
of such alternate m mXory.
FINAL MSPOSITI0N
We wrsrm eWsdaFl W Move the«mnaaid Kmans Of the Main ft« Mry u:
Home: M B parer FuneMr Home
Adder; 123 Man St.Arrign, NY 12809 pI STIOMi 18
TM«&rNpd remains INdaOeaW will be dsweStlINsbllows:
If Moral mR Mrf pemn named seas Wass rMtek6 gssessurMMearemMd Mnww.
Pney CMmatmy •aWwrm]W the pc wm of
Me remains to M.B. Kilmer FureWl Home pMwxmm.d bV"$ N
In pwwn or 4r li m"I. nxevrwArmy AnnSrw.n
DOS-1S9bt(Wv.OM20) ra�x Ppa2 of
Authorization for Crematlon and Disposition
l�tia ht.hPoxbw)
xWNW IMA dndemMne MMnMemwmam mtaairrred nmmml2oagveauwnaeon,
fl^a VWr crwnatcy may Mepcea of the rmainain
lneOlNeEk manner ouch as by sCMMg rmmvr"mnv
an
CREWTION CONTAINERNRN
(Dial ONE orma Mowed)
An urn st M use0 as a Pomalrer am to wedged measure has Caen madams such,
and is described as mllo r.
II understand Mat it tM on is too ameA N hod Inge any man" remains, an addltlonal ngA container may Coo usa]MtlelrvW.
V yl] AnumianNptputNBMd. IMUun Wnd NMifmumuputle9MwcOnrvneept
I` ang[dgW tlN vemsed NmahaM
s hiEmissionsmneiner for ndlrvery. ng+suc�n
This AUMwhafbn Fomt Was Processed Took!G Monsoon wy uyuM at
ryrmsuw-.w+N
M.B. OMer FunaM Home
mtimxwm
In Main St Power NY 12603
xveauN
and Is signed by the mnaral dhevlor a'MON W ee It
IMb has rearvad a ommposter copy a1 gis AUMarmOman Form.
sign
No to and antl CommmeYre oftlNMotmNon contained In Mi In con"0 conh�SI AUMorlaaC n For lm end endommesl thedenial
ng. sl
Slpred Me 17N dent June ed20
Manor Day
WITNESS: I
Todd G. inner r,
11079 rigfwnmwmr ism
m J%m Mm Brown
DOS-109V(Ri O45!0) togre ld