Kim Jr., John Pine View Cemetery & Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: pI RETURN TIME:
DATE B TIME REMAINS ARRIVED AT CREMATORY: UI IS Ito 2:00vh
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
NAME: 7D NJ eLN CASE 749
TYPE OF CONTAINER: ITLSD (65O.:' - 6dyif OAK CR[Ir(g--
PLACE OF DEATH: _5ra AST 00476
ESTIMATED WEIGHT OF REMAINS L CONTMNE SS 1RJ Ls SraIC
PLACED IN HOLD: Z.TD Pn
PLACED IN REFRIGERATION:
DATE OF CREMATION: -20-L0I
TIME STARTED: 7o TIME COMPLETED:g/A�
PLACED IN RETORT: 7W� MOVED: Ham- N
RETORT Y IN WHICH REMAINS WERE CREMATED: tYA& = pq4oc ./1 k
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.
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Authorization for Cremation and Disposition
TM1N AuMorlaa"ten Form must be comgeW and signal prier t0 MMary Mrmllu hoar fin.
w1e: 06/1612020 Number: 7y9
Centel" Name:Pine View Cremat«ium
agdreas:51 Quaker Road Queensbury NY 12804 Plane: (518)745-44Tr
CRpA1Tl0"IS RX IRREVERSIBLE AND FINAL PROCE99.
Cremation is call out by places this remains m the deceased and Me wmainer hddirg the remtina into a venation Member wneR
they am subjected m IMenw feet and flame. TM adult and flame will Incentives and consumer sveryMlrq eawpl bone anal meal,
N1ilch am all BW will be IM a cwnaaon.
Fdbxing character.Me crematory will take mistral eXoda to common all of Me remains and enter mebMl h«n the«eml
Wmber, but some minimal dust and residue WII likely the eft behind TM mwMPmrytall separate covert and hon ign maiedal from
Mere and Melnddental and foreign mmenel all be ao diatmoed ofas ulad by law. The«emelal rtmainswill be mecaaniuly
pulver M Imo ini pema and paced into a designated comelrrer«um. CremetaalranaimpenanlHampulvaX undlra
smels awmmd Is reochrou me as skolmal Massie.
OPENING OF TXE CONTAINER
The«emet«y may only open Me evidence holding Me uncremated human rental In limited circumstances such as Io Confirm Me
identRy,of electrical orM enauretrn no malenal is enclosed which might injure empmyees ordamage the cremalwy property. X
human rymalns are delivered In a contamerwhlch is me auNbNbr cMntlbn such as cenumonlal or cancel cal the
miserywin require Mrr morammN mmoved Imo.sulmWhm main yang all W diNe Meremains. mecgairg ae
conminer«Me transkr or removal of arreina cent be aMvebd Whom ewMeas eM trill be dale 1n pnveq,with dipniryaM reepM.
OENTIFCAT IN OF DEOMED
Name of Decrease; John Kim, Jr Naidalstehe: Neverlierned
taM Known Mdraee:M618 Migratory 116, Rica, CO 81332
Place d wadi:. . Samford, CT 08908
son,: Mrs OF the: 33 006: 10,2wim wNmDeaM: (XIOW2020 EdirnmedWeght I4S
Don«iptim Of uak&/P mice in which Rmsim an the tl named.
Milso Casket Company—Oak Casket
PERSON IN CdITROL OF D S"MON
(Parsm(s)m cMOd Wdt(nSilMr. MRId ONEdthe Mbxinpl
1 eMWe ere Me designate agent of the deceeaef designated in a will or wmtm Ivdumem executed purwent he Public
Iwnh law Siegel 4201.
Ilimits have no oweveeae that the demand exealed a Wnhn 1r4numem ouauam to Pubic"earth Law Sell 4201 m a
'n idea alrections car Ore dNpovhm of his or her remains and Men are Me personal more money under Pubie"eaM law
on 4201 and have Me ram to 6uccome abandon of the rental of the eexased fall ralebonship No the Wceveed N as
Mlwn:
John Kim, Jr
005-1 Ballot(Rev. (i Page t of 3
Authorization for Cremation and Disposition
mr Mm me Ica beapwl
Nuuker: 4 Tomorrow Father
1. Apenon deugnatedln wMnp pmawnt to PWIC NaNU Lew Se 4ZIC1(3):
2. The surryl aPoux'.
U. The sun'IVlne domestic partner,
3. My mil chile eighteen years al pa a odes
I. A surviving currentl
S. A surviving sibling eighteen years of age or olden
S. A lanai supamed guardian;
7. My
lnl�fiduveryarN eem or door entied tl to share In the eMa and who ldare dorsal relationship b Me disposal
8.
e. A dose treated or rebtire win has computed a mean abbmeM pursuant to Public lNafth taw Smmon4201(7);
10. Ami fiscal officer d a county or public adminiM apdnb]purauenl to has Sumgelea Court Prompt Act
1M. My char bell win is hung on deMM of has decuesM and win has executed a wnMn sbbmeM moment to Public Hall
Lw Serious 4201(7)
! ALL THREE Nthe fichow l
IrWe ndebv amrm mat tb bWyolule Oa Weeed cuss ndmmm�a MEery.datlerY sob.Wwer ion. orbital Implant.
a MdecOux device and Nnany euU mebrWawere rcmowdpmrotlnevecudcn of Mee luM«ILaMnF«m. Fallunloramoae
Rams pMr to moral an"used[In MM b Me sramelary and«amabry gnenML
Il Won that Instructions hawsr dean given d Mat J. D imone
ardli g tte rmnoval M ant personal nrgMy or olMr Mop M vege whkh any wrson ingMng NIw'cr any mnly manpower"
contended wishes b «ass", Pine View Crematorium
is not respdnal for the remote 0 personal Musa"in the wMelrnr w from the remdns al the dsMaM. Punched in NR In 1M
999ppp"""¢¢¢IIIInor a wah R»wmolm Mn the channel by the crawMe Improper and cannot rental*her awneddn.
lJ / sop Mr yadM Pirre View Crematorium
mcnmd.ft ransom aR.d.ro.sesd.
((�ovnavay
mom hereby aumaM the named Nnaal character Up pooada for delivery b and criamlon by an aMmah
rametayRce neceenrY in the opinion a tin lurmeral simmer,and m amend this form to prowme tin comct mane and
wdms of such.Hamm mumul
MNAL INSPOSIMON
The perem thadernmed to raceme the uemalnd moral often document from the«Nnlpy or
NNn:John Kim
PWrcn: 1872 State Route 9, Lakin George, NY 12845- Pnpne: (518) M-5700
The nmrebd remf m a Mwaxc and M dNporl a an nose:
Return to family fa banal
door my meson the emus named aWre does not take gvaeYan ddu command nnwin,
Pitle View Crematorium d epteaivd to give downulrn9
tits mwnain to Reroarn Genny Stafford] Funeral Home or delvers
in wrean or by registered mail. John Kim, Jr
w..wasm
W Ifrri(Ray.W2o) P"2 d3
Authorization for Cremation and Disposition
(1 Ma MNwy)
IMb ureassland MN HHn ram ens am ml wimW went rza com acre'm0aa
Pine Vtaw Crematorium mry dpaea ofnw nmaina in
an isimewralM manner, aM as W eulrifing n�.mcn art
CR ealkhON COWMNERNRN
(Inl1al OME&Me(dbwingf
Regan Oanlry Stafford Funeral
M an to be ueM lea mnbwr for his cremated rwnen M1ea been purchased Mxn w—e
and is dronthad as kisms,
Ifflee1111understand MT HMa end N W mnaX to Iwld nanapre aemabd mmana an tl1Rmal raid container mare W wand W"Into.
+Mumb�al yet piutliased. tMle urbrerend MetHro um le WNacetlmadN+'Mw pmnded
JJ Pine VNxy Crematorium idyl pace uv memories Teri In
a deid remlMren aamemer Ind aaNey.
ThlsaeMmaadon Fmm pmdd W Mark J. De Sinnrnaw was ex utnd at
Regan Denny Stafford Funeral Name
53 Quaker Road
d. Queenabury, NV 1MIM
and is asned e formal as as M ecudon
Ey M e wtrn isxa IfNe M1are rmeNnd a mmpleted Was of Nb ANEmhal Form.
meu � mewianwMHnsmaresa)'ei a
m smmm and gm ne Imntio w� uw A � a treamlqusrvchni
aiacedmle lath es, June ,yp 20
John Kim I
1572 Slate ftute 9 lake George Ny 121WS
awwevTWomr wM w��`"C+� ��`
John Kim, Jr
WS 11 f(Iran, WINO) Ppa3N3