Hopkins, William H. Pine View Cemetery & Crematorium
Quaker Road
Queensbury; NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: NR tWya, RETURN TIME: /�,,
DATE 6 TIME REMAINS ARRIVED AT CREMATORY: W13Im 11; f0 7
NAME OF FUNERAL DIRECTOR OR REGRISTEREO RESIDENT DELIVERING REMAINS:
K4cs yuwi
NAME; ODUB YfigPS �R CASES 7Sr
TYPE OF CONTAINEII: Fkoa 4W // 6DId/II
W.PLACE OF DEATHI IU [6f Af+ (/ 4 f 461x. �If M nc�z
ESTIMATED WEIGHT OF REMAINS 6 CONTAIHER iiv ILF / IMf Re
PLACED IN HOLD;
PLACED IN REFRIGERATION: 1
DATE OF CREMATION: I/4131"
TIME STARTED: I, 30th TIME COMPLETED: 3I0 QYI
PLACED IN RETORT: I140Pry MOVED: 3�I
RETORT R IN WHICH REMAINS WERE CREMATED: iq% &LLAV
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 40 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE; THE CREMATION LOG SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
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TTVORK Division of ONISIOon,Ce ET M...
STATE OF pre C al
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Tel.n one.N18147"1
Authorization for Cremation and Disposition
This AUNortra Form Mort be hemp1Ned and signed priorm aelivery mmmelm Amcremated.
Deis; 06119I2020 Number 7�
crematory Kama; Pine View CrameWry
Address: 21 Quaker Rd., QueensburV NY 1280d Pnona: �5161 114C-N
CP nON W AN IRREVERSIBLE AND FINAL PROCESS.
Cmret'nn is wined out by deal the remains ofMe denased and the container riding the remains am a wmanm chamber where
they are subjected to Intense neat and flame The hex and rime will mcrosnm and consume ev ing e6ept bom andm L
"fell sn xl Mat will be left said t aeon.
F011owirg cremation, the uemakry willtake namable eflwt¢M remove all of tin remains and ocher Malachi hcm Me uemetion
cameer. but come minimal dust and residue will likely be Ind bMnd. lbe xmabry will mm�te 'mutlenrdl aid brei9n meledel hom
Me remains and teemordimx and roreign mMdal wall des tliapmed M as howned by Iew. The rmm remains w it be Medwrdcelly
puNedudlmo small places and plantlim0 a deagne mndinmarum. CnmatWmmaimgemmiyompulved uMlm
single fragment is recognizable as skeletal Nasuo.
OPENING OF THE CONTAINER
The crematory may only open the comalner holding Me unuormatM human remains In limited circumstances, such as b confirm to
Will of the deceased or to ensure that no mabnal IS endosed which might injure eintommea or damage Me immatory property. N
human remains an Miivend Ins conYlmr which Is not suitable he cnmstlan such as a onial orrinYlcmkxthe
o abrywillrequire Mxthanmalm WMOVWIMasudabloconYlmrMon IIscripts Mar aim. Theopenly Ne
wnbimr or the transfer or removal of remains will be conducted before a witness and will be done in pnvary, end dgniry and reaped.
IDENTIFICATION OF DECEASED
Name of lxoeemd: William H. Hopkins MamaI Sins: Manned
Lear kmward Address: 12W West Mt, Rd, Ap11109 Quee08buN NY 12804
PIM of Dram; Grandlle CBMer
Sea ® M OF Age: 89 GCB: OW0911931 Oweerneath O lMO20 Esbmamd Wegm: 120
Desorption of cox mnlaimr in which remains will be delivered.
t-' (Xwol CA 00, i?D
PERSON IN CONTROL OF OISPOSMN
(pPoram(a)m amlMddspsadrn, �1 CNE olrM/oNownp)
uh l{ IxNYle are the tle&graded agent 0 Me dtw_aaed design In a wall or written lndru ment executed Forward to Pi
Hmllh Law Saticn 12H,
OR
Me have no coastal that the de®a.ed directed a wrilMn instrument pursuant to Pi Hearin taw s%tlM 4201 ma
ad woodland d riallos far Me dlspoellmn a in Is or her remains and line am the m%n(sl having priority under Pnbr HmM Lee
Section 4201 and have Me right to assurance useful of the remains of Me demand. WMur mis nship to the damuN Is ae
Follows
William H. Hopkins
weed
D I fflav IRay.01l20) one I a
Authorization for Cremation and Disposition
_. nmtrtmwn lm 6xeeWW
Number'. 2 p nptian: Sioduse
1. A person deMinaled in wham purewmm Pudic lteaM WBem QOI(3).
2. Than surviving spouse',
ad. The surviving donwtic panner,
3. Any aurvmrg child eighteen years M age Of order
A A svNM%parent,
S. A surst ing sibling eighteen years 0 Me or older',
6. AkWay appointed guardian',
T. My Oman($)wasken years of age or older emitted M stare in the estate and who Wwx in rNkifi re pWtheyd 9SO:
S. A duly appointed fiduciary of Me sublet
9. Adose Mend or relative who has evewMd a sNkn atatemeM pursuant m public Health Law Sec(nn 4201(7):
1g. A Niel fiewl oWur of a wanly,our a public ad aerosol apparel pursuant to the Suriname'a Court Prpnure Act
tea. Any other person who is acting on be hall of Me de0.Vsad am who has erncured a wrMen salmi pursuant M Pudic Hwhh
taw$eson4201(]).
(inns AU TXREE of Me fa4owmgl
J6JR Ave hereby am"Net the body M Me derease] does not contain a here ry, barely pack, power colt, ra]mctiue Implant.
or rWio9[tive arsine and Mat any such matenamwere removed pros W MeerecNion Older AU Maaran Farm. Failure W remove
it Pnv W cnmMbn may Wsuh In burden W Me CMMMry and cnmrtdry pWmkd.
IMIe aMnn May instructions MveM given John Alexander
regarding the ramoval of any leynonal prppmty or dint thin of value which any perwn sgning made or Any Wr m6mba of Me
deceased wishes W passer e. Pine Vim Cremaremory
is not remarkable far me removal of personal xemshamtim wwiwr ahan Ba remainders dweawd. PArwnallM1melenin Me
wMainer or with tin remains will b r d mWWJ by the smne6dn pWwaA add cinnd by nViWad All channel
RH Ilwa hereby awhdmA Pine Yaw Crematory
Wmnra..l MrnmMthennwlmdtlndas 0.
(Irvtias OPTIONAL)
RAN tars hereby authoua named Wmnl dlnatorW small delivery Wand crematlan by an aM
Wry, it d«mW necessary M MA opinion dins fu lduration, and to am.nd this roam W prmide WA coma mnaand
wdm dsmhalWMMGcrematory.
FINIAL DISPOSMON
The person aumordnd to remivA the vem&ed nmaias dthe demared We 6a a endoy is
N.M. Alexander-Baker Funeral Home, John Alexander
Address'. 38o8 Men Street Warrensburg NV 12885 Phone: (518) 623-2085
The cram mil mundane ddewasad will bA disposed MAs bllcvn:
lo!kA L ku A+>e (Y >aM1{y T SA RCs
If Mr any amm Me perwn ramM abase does W We pusedian dtM aameted named,
Pine VIM Crematory p euMabed W give m mwian OF
"we", "M
Me remains In Alexander-Baker Funeral Home Wgamely
in person or W regisnred mail. William H. Hopkins
DOS 16964(Pev.Celdi a� Page 2 Of
Aµthorization for Cremation and Disposition
the doevi
�� Fwe waemnna Maldha remelw ere lwtcwmed wiMm lzg myammmmM,
Pine View Crematory may depose Wave Meadow in
an imtrlavabe manner, such as w scenering
CRRWT COMNXERr11RR
( ONEdtlre MkwmB)
Alexander-Baker Funeral
M um to be wee as a container he vemsletl minding ha Even WxtuaM M1om u.....-
and is marriage as lolbwa:
Me YMmtand that X the an urge amall to Illt iM kohns mNd remand, an ad]IWM rpb mnbMx my IN wool fro dNMry
-0R.pny M um is net yet puMaded. We overall No if m um is Purchased or whereas ppvHM
Pine View Crematory pall plow Me awmaed remains in
a rgNbmporary rorminerbr Mivery. m...rawd
Tka AUMorimaon Fomwasp WWEy John Alexander urea executed at
Fwvam.mww
Alexander-Baker Funeral Home
rreet, W trig
3609 Main Street, Wamenaburg, NY 126&6
and a agree by the fuMmi director as vitwwb is ewecaEM�
IM/e have received a carnweed ropy of ads Auawmaam Form.
The"Rome)lewrenw helow wan Me indexes)In control ntaapmpted,who IN signing this Awnwdw1w Fomh zhesas)
b the etturacy and completeness of IN Information wedulned In this A UMW SOM Fomr and aaherdam)the foregoing.
Sigwd this 191h deyea June , ad 20 .Barbara A. Hopkins �1'loee.�+�- /g1 tgas ^"
4N Goodman Ficted, Joinnelourg, NY 12843
va1Ne96:
John Alexander
owm.no==�wwew.x
10036
Wiliam H. Hopkins
Ia.-+owe
OOS-I llg6i(Rev. deride) Page 3 of