LaGoy, Scott Edward Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745--4477 or (518) 745-4476
FUNERAL HOME: ssf RETURN TIME: _ qh
DATE & TIME REMAINS ARRIVED AT CREMATORY: _ . GI'I M M d70AM
NAME OF FUNERAL DIRECTOR OR REGRIISTERED RESIDENT DELIVERING REMAINS:
NAME: S'OII 4GR CASE IBC
TYPE O f/-1 ( Ybw 6%1/ �A�'Mpl-_
PLACE OF DEATH: GAF KIUFVulel ESTIMATED WEIGHT OF REMAINS & CONTAINER -I ' ISO I 11
r
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: .Un IOIiSIM
N6 y
TIME STARTED: II' /1I0 TIME COMPLETED: 'I' ewsPn OF.,
PLACED IN RETORT: II-ts6� MOVED: ILMQ(� I�QII (Ibrl l
� O��� (f�T��
RETORT # IN WHICH REMAINS WERE CREMATED: p_ SIfF� Pit •�
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SMALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
GP NmMM wild
NEWYORK Division Of omsloH OF ryMxEren co^n
J�IIR�RIEOF P
OM
Cemeteries
op
Ir .T, (5M)<tse22e
Authorization for Cremation and Disposition
This AUMWzsftn Form most Ire comp and synce prior to delivery of remains NrcrMr�on.
Dale. O6/1912020 Number. 'l49
Crematory Name.Pine Ylaw CMM8Wlium
ACareae:51 Quaker Road, Queensbury NY 1281 coach. (518)74 77
CREMATON Ian AN IRR RSIRM"D FINAL PROMME.
Cmnation is cot by placing To rename of its sa urai and lye wraWwr makirs tin mnnm Into a oemation"u wlmm
they are sugrl to intense beat and name. The May eta flame Mil Indnanb and consurre ekmry rep except Icon arch maY1,
which are all dW will be watt slim crxrutlon.
Following uemal the wmal will take reasonable endue to remold all of the remans and once mMenal horn the c m won
chamber but wonb minimal dust and reactive will likely be left CMiM. TM cremalpy wel a rN Scandal and forego marenal from
the remains and nos Inodenbl and fosipn maimed will W disposed pop required by law. The w mend menus wA M metlnnicBlry
pulven2M into small pews and pladid Into a designakd mrlbineor um. CmrrMW nmalne generalry are WNadcad spot no
single fngmeM4 M"nivble as ske1 l all
OPENING OF THE CONTAINER
Tim vemamy may only down fire wntainor holding the unsweetened human remains In limited o-nunawal such as to coMnm me
Merrilyofinet asetoreensurethatnomanualismdar whitsmightinjureemployeesedamege Macrem Wo pmMe , "
hummr ift are dellWrtl In a dmlalnerwhlch x netsultabxfor comma,Such as wnmonlal or nnW(dell tM
cronnal will require that and remains ban moved Into a sutxb"container b mN 8m8M Mer ins. The opening Nan
container or the trenafer or mmpal of remems will be roMWed bNon a sMees and MII be dote in giMq,wM tgnHy and reaped.
IDENTIFICATION OF DECEASED
hams of oewasm: Salt Echal LeGoy MmpelStaws: Dirimi
AN known nedm 26 Pine Street, Glens Fells, NY 12MI
Raw of Dean:Glens Falls Hospital, 100 Park Street, Glens Falls, NY 12801
Sea: ®M 17F Age: 56 doe: 01/01/1%4 wMaCroM: OB JM020 ENNnaM Weght raolb s
description of wket/wntaiwr in whkn nowns are W abasing.
FiberboardlAltemal container, Matthews Company
PEnaox IN CONTRM OF Dnp°amox
(i6rsa(S) m cmbd d Gs{o ,aril ONE of Me folbw1al
IwN!/e are the designated Agent oche deweved designated! In a ad or w IMbNMnt emcu Wnuem 10 Pri
NAM new Swtlon U01.
aN
x Me haw no moral net the demased Sandaled a written instrument pursuant to Public Neat Lana Smtion 4201 ora
win win ning directors fin No dkpwition of his or he nmeins and Its are Me will Iwrmg morhy under Public Hl Law
$ n 4201 uM Mva Me nehl to aduchas uemmm of the hoses M nu dewased. Myrow nxlbmhipW amdsdeeeW au
dnewe
Scott FAwartl LeGoy
DOS-lN&f(Ray. 0420) Paget of
Authorlgatlon for Cremation and Dlspositlon
(Inwd Rm Melialpe )
Number 44 IMacrgtlan Surferma Peru[
1. A painful designated in wNng pursuerAb PUEW;Hill Law Samoan 0201(3)i
2. The survmn9 accuse;
2a. The IurnvinO Monsanto carmer,
2. My sunivmy Grua ecall reap W age or older
4. Aformal wren
S. A surviving sibling eighteen ymrs of or older.
0. A kwlulM appointed eual
T. My mmm(s)eighteen"am or age or alder entitled to sham in me encom and he ie'aee demand in substance to W moral
L. A duly appointed Solve M the estate;
9. Adow Mend or relation who has erreCNM a annual America Puri to Public Heath law Section 421(1);
10. A coiel fiwl officer of a aunty or a Public adMontral eppoiNe Wm«eft W the Senegal a Court creretlure Al
1a. Any OMw denon Are is amine on bebn q Me deceased and wed lift ermamid a wrmdn[taremem paml to ludic Hearth
Law Sumiar 42019).
THREE or Na ldbwing)
�( Ca '�M4e Mnby eMrm 11n11b 0My of Me deaeseddces nq wnbinedTlery.EeMry peek, 0owarwll, re0ioediveimgem,
wmioioner deNtt and Mal arty such metal were removed pnmW the 0mcul o1Mis AumWtr Force
M tine polar b cnmNlon may must In harm W th0 cmmalwy and mandatory mn nnel.
(rfH IM14e elfimf tnnl lnaVudlman«e E«n giv«to Sarah A. Philo
�C nw
fgerdur0 Me removal M anY parwnel pfcpefty or caber Ihifrp of wla whrF enY Pomcn agnifp bebx a ury Retry mania dtlra
comment wlabe to preserve. Pine View Crematorium
.nN nspcnshm roftM removalMparaoMlilBme M1om Me wfuOiMroi Fdm tM emaiN came aamased Fiscal game left In the
�bem.Ra.orwftn 1b mmlas W II be a«rw«d Ian eft cnmalim coma and mnnq be reMavatl finer mmmm.
X CCM I hembyaWhobe Pine View Crematorium
comma +m
Wce W Ib realm o1 Me decreased.
(1PTIONAL)
Nan hereby authorize as reo provide ben deNery to and Overseas etlon by an seasonal
rd c .9d" ansaln�odnlonof aldt ,sWtoemndth4ftmWmtaxcomc nomenILm a
FINAL DISPOSITION
The pawn nemormad W re«M Me mre remelns Oft da««eO hom Ce memory 4'.
Name Singleton Sullivan Pother Funeral Home, Sarah A. Phio
Access 407 Bay Road, Queensbury, NV 12804 Pnom: (518) 79& 9
The defendedm nMd All be discover q as 1a' erry
To be reWmsd to his model Carol MCNaughton
N Rrmy Mend the wren r Note h«Md p«saaa4n cant vemeW nmains.
Pine Yew Crematorium 4e0adsd I Me pot of
t`mw .rwan
Me Moore to Singleton Sullivan Pother Funeral Home pay delMry
r�we>mra..r
in colon ortry mpwred mil. Scotl Etlwertl LeGoy
Al
�1 III(Rev 04W) Papal
Authorization for Cremation and Disposition
rbG+&dm wmnnpl
c�yore wteNrona qN xqa remeiro are am ueim.awmin 1zb aye ammadan
Pine View Crematonum mg6¢ppae orgeremainsm
iw.mc...mh
.n iiremev.ae manner,such in m vavadrM.
CREMATION CONTAINEMM
( rQYE OImB b/bwi/pf
Singleton Sullivan Potter
M um is he used a e wmemar his the dmmabd mmeina nest Item pwanaea ham P.........i u....._
arm N decided as tolicam
Ivan untlerstand met lime um is too area to held may sued cartel remains, an additional rgla uhmmner may Ire used her delivery.
^aR-
X (I Cyyl Mumi¢rwtyetpur a¢ed. NVe uraMmrM Mal Mrw vni¢ purGtawdw NMrwge provitled
Pine YMw Cremabrium will plane the cremated remains in
Mandawal
a held YrrFwary cwMinx la deNmy.
This Augorlaeaon Form"a prnCN by Sarah A. Pluto was executed at
Fer+noa
Slrlgbin Sullivan Potter Funeral Horne
4g7 Bay Road, Gue inabury. NV 12W4
aM Is vaned dy Ne Niteral direcmr as wastes to ll¢sandwich.
used here reversed a completed was of this Augorleellan Form.
The pardiala)MerMMd Irelow Where as pistons) In Cannel W dlspa lan,with,try elpMne the Audiovisual Form,aXesNel
tithe se rurary and awnplN nns e11M Nfarmebon wntalrrM In thin defendants"Farm and autivtns)1M scandal
Shansi 19M dayal June
Carol E. MCNaughtan
a Lanka Ave. Shared; Falls. NV 12831-
smisciosmismse, w•
NOtNEss: c�yi n r� �
Sarah A. Phil
a..-eu.m,nwsreurww �asir—m
12W9
Scott Edward LaGcay
wm.easm
We-189"(RAW. MO) Pge3 ci