Hayes, John Willaim Pine View Cemetery & Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (518) 745-4476
FUNERALHOME: _ _ RkNAPDu RETURN TIME:
DATE 6 TIME REMAINS ARRIVED AT CREMATORY: LI zzim 2XM
NAME OF FUNERAL DIRECTOR OR REGRISTEREO RESIDENT DELIVERING REMAINS:
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NAME: -11 DIIrl rMf1l."i ASEP 791
TYPE OF CONTAINER: PWGyIM� /I(,U10 4N¢TIHf
PLACE OF DEATH: er(Ar fA16 f6pfi1
ESTIMATED WEIGHT OF REMAINS 6 CONTAINER _ AD Iic
PLACED IN HOLD: 0�.,
PLACED IN REFRIGERATION: Z,qn
DATE OF CREMATION: LI2)) 10 y
TIME STARTED: _.... TbAtj TIME COMPLETED: I' 4s
PLACED IN RETORT: '2:>8A0 MOVED: 8-SS Ail r �
RETORT F IN WHICH REMAINS WERE CREMATED: aj{ c
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN AS HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE; THE CREMATION LOO$MAUL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
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