Barron, Francis Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NV 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: I D_$__ ___ RETURN TIME:
DATE A TIME REMAINS ARRIVED AT CREMATORY: 6IZII 110 Q. ISAM
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS: -
CAI too u 05T,Wt OA
NAME: FPAOKS ER"M) ^ nn��CASE9 -J _
TYPE OF CONTAINER: I� ! AIMM1vt- •LI� 6 Hl�nn} Iw�L� a.0
PLACE OF DEATH: l0 fwq L I(( a Sfr, I U 11931
ESTIMATED WEIGHT OF REMAINS A CONTAINER 60 (AA
PLACED IN HOLD:
PLACED IN REFRIGERATION: IL��
DATE OF CREMATION: YIN)b Ary
TIME STARTED: I<.00AI1 TIME COMPLETED: IC"I'm
PLACED IN RETORT: _ Uo An MOVED: I RD AM . RL41A11
Q-. T—
RETORT S IN WHICH REMAINS WERE CREMATED: S0F$ ls0 A1Y
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN AS HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
NEW RK
"A TEOf DMS I Division of D.pw myetaw
NOFF MREMFE
Cemeteries
♦elepMone.(5013E(N621E
Authorization for Cremation and Disposition
Me AugpFln Pom must M c WkW and ulplMtl prom NOGIIwry W rmWM for cnmstlon.
oMe: 06/17/2020 Nummam: s /
CremebM Name:Pine Yew Crematorium
AMn rs'.51 Quaker Road, Queensbury NY 12a04 paw: (518) 746 77
OR role
N AX IflflEVERS1eLE AND FYUL PROCFAS.
CnmMbn Aumed me DY pact Me aameina ag MeE 9n 6And"a confiner MGrq IM Moo
me uema40n cM1emEm wMA
me IW aWyetlel as IntAtom heeI and is TM M1NI and games
w111 mormnn eMCMFumeewryMlnp aawpl Eon eta mMal,
whoa m a I that will b lery*Nw cnmetlon.
Fdloxing cnmaton,IM1e crematory will lab msmeLle axone 10 remove all N Me remains and ulcer maleeal Iron tR cremNon
The Is F bSl some mmi mamust and nLdue wia ukaN ce lm deland. The odmalory oil eepemen in demM and loreien materiel awn
IM remina and Me incidenfl and loreien Same
At M diappnd Nee morel d on
law
. lire some
BMd human win a macMnrJry
wlverized i1
0 Amen Piers and vk N imo a hsien.ted anbmer«urn. cnmMN nm.W aerchnr m pulwrked umn n
.;naM menu ie nwpn4l Am skated Wew.
oPEN NG Of TXE COMMEN
The «emabry met Only open lire wntainr taking Me un<remakd human remains In limtled drwmatanora, Such as to mother M e
mature Of Me deceased or 10 ensure Ihat n0 material 15 emlos¢d whiCi mists injure employees or damage the crematory property. N
human remin en wellvered In a container"An As not¢ufable tot cremation such M wnmonlO or nmal nekX,Me
mebry will require MMXm main be m"W kb a suIMDN container beton Naaepn the nature. 1m opening ha s
wnbirer 0r Me twnshr Or nmovel M remains MII be pMupetl tel«e a wxMaa ehd MII be donB in pnwry, wth dpnilyaM mptl.
D
Name W Cecurned: FralKla BIAmon Mannl Sffa: OlgrCed
teat know,gamen,40 Famest Lake Way, GmnW Ile, NY 12M
pace of Owtn:40 Forrest Lake Way, GMnWlte, NY 12632
sm: ® M OF Age: W dole: ON17/1936 Date N CwM: OWM020 ENmwwwmgN 190
CescrigiM Of nelnM¢nY in ufi n mNN be delwared
Alternative Container without interior. Matthew's Casket Co.
PEItaDMIH CONTROL OF DISPOSITION
(Y MV Mbases d150mxm.�l QYE am MbNhp)
Xw )r77
amtha connaed agent N the Nnned dngntad M A atilt Or xiilbninaWmml ewNttd puhueM b Pal
edpe lNt IM1e demnd a AOc d writle0lnaan am punuaM to Public Neext Law SeGon L3el ore
A some distact OTTAABA rremin end LMC aRMe pnon(e)MvnB PdOtxY UMer Pudnc Xnxh pew
iZto witOrin werntl a the
MmainsZ0 WhnaaM. NylourlWtbnalpbMe dacWadYn
bNow:
FlanCiS BaffOn
rmwsvr.4
DOS-1e93f(Rev. NOM) staff 03
Authorization for Cremation and Disposition
Oruro dam'ma/ ae mxrwl
Hwnmr_f_ DeaMaiPr:�a.JT. 1p1�F30 rnr"
1. Ammon commonled in wrNy PURuemm Public Hxtlh LaaSe a3ot(3):
L The nor spouse:
:a. The wrvrvbe awwtic wooer:
3. My sureang Mud egnben roan M bull or Older,
l AsuMving wnm:
n. A wivraing siding stomach years of age or alder
A bwlul"Pmnme grader.
My pbAoas)eigmYn seen a am or char enlitbd to share in the Male and woo We re donnish Rblids" ip ad and border
e. A duty aPommM famously OF and
g. Atlne found or 2mlub Aid has reserved a women abmmem purl b Pubic Mouth Law SectioMX11(7);
10 1 oersr Ne county R 8 man admi rumor appoimetl Wnvenl to IN Summered O url PraxeuR P4
• AN
offer or am is and m behalf 0 the deceased and wlro ode banned a wnden Moment punuam m Pubtic health
ALLTHFEE Imhddeari
torah by afiUm IW tle body M live regaled does W contain a battery, barely pack, power all, rwliwGwe impenl,
ndiw end lmtBM wch meleneb wee RmaMtlpvlo led evefNbn al Mb AWno,ixamnForm. Ftllunmamoes
th rto cadmium;may mull In harm m IN cRrnsby,and cmnamry sammnnal.
aMrm tmllnstulons have men given Cdesitly VOD$t¢Wn
w .wq
amNg the hovel olyry cersonlaWeMmdMerlRFp avahre wNN enypxwn stomp mbwor erry emly merrtler pldy
as to preserve. Pine View Crematorium
rwlreaPonslp Ip Me rtmovel olpmoMlikms M1om the wMelMror hom tin redeems 011m deRued. PenrnalmmseXlntm
imPgArar 1n. mole ynumeatroyaa by nR er«mmnPraaua me annnm nute..a.mrcmm.uon.
auu2rma Pine Yew Crematorium
a mcmm led mWrw a Me ExuaW.
PWL)
rUl `� u.. n.rwy.umarw u. nam.e turRal Nr.amrw Pmale.ro,e.Ilary tonne n.m.pro an.mmm
.aa 0 such.N.M1 reamryp,y. apinbn arlM wrlsnl anclor,.mpumne del.mph prowl"
tlta ct rpVand
etokrej
FNAL DISPOSITIONtM IaPI B0 Veto
The person aulMhaed to helve and cwnabd Rmalna a IN banal gross IN marine,s: K� gel3ll �LC�Q5fh ro
H.me.dOtR9a2On Seea,ne�m ILLshn�PnhYl0'CX0611V
Mains: Pedro: �'
Tm mmew m.ins aaeg.aaw3lm agraklm:
�OWMBC1oJBFTBAaOD Ma I�o K�1' rr r� s '�t�sh � nlul t � ,D
2Q21\ loOrk 4Lid Cxcg6 :IC I sous PariT� K( a„ jjnn v
nra any 2.antm Petea reiae amream namm -�rmde..mn halm abmm.;Rmwn
Pine View Crematorium a buhMnd m give raker of
ntei wy
IN amvw to _ _ Repen Denny $Waora Funeral Home by darvwry
a+ww..lw.w
m person Or b/regllmrea mall. Fronds Barron
nn.-an.s.ww
DOS-1e91Yf(Rev. Mull Page 2 03
cation for Cremation and Wspositlon
V robe wi
w✓ umbmbna Nn dam mmems am net aeimee whln uo ayaatlxrmlmn,
Pine View Crematorium
a manner.s� e.b "°"""' m.y dbpn.e aloe mmewb
r awn.nnP.
l�w+F ears ammn¢)
An um tO be used as s mmnver a me vemebe Immelr a hem pear purchvced4om Regan Denny StaItOM Fweral
one 4 (Attendant as blow'
art der,"m an
he"a
srMAbMtltl'e"I'mamnded,amens.me ee"whadwp awashmneed bet made M daFmy.
Mu 4rMyet PurtliavM. W/e wMare4adlM M m urn is inwhased m ogler ehewled
Pine Crematorium wiupaw the cremated mmelne m
4nWerYwrNi,erMeefyry
n AutlpNaean Fp msprwtd fia551dv VOn5te9ina was exttuled at
Fuanai.vsl
ReganDenny SIXMF Home
0 Quaker Road Du enebury NY 12894
ON 4 eipnad by the lurmlal chamber ea mgrlees W i s evecul on�ww
IM14e hew mewed mnplewl COPY Of this ApgMia llm Form
nbe
Mewaaarms and cone nm w MepMnntileaen wn4hwdtln Nb Autlrorgess Formhatecolgon,what 4 sign lwM AncemenllMors Fmm.oling.
rlmfel Mabraaolrq.
starred Nb t]th yayy June
f\\7A.Aa hry ayg�dj'j ,V1 q �K
11,1
n.,. mea,
x+rnFHB:
Cessitiv Vonstettme
13]09
Francis Barron
Dos-lase r lRer. NQO) Pape 3 of 3