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Hanna, Edna Pine View Cemetery & Crematorium Quaker Road Queensburyl NY 12804 (518) 745-4477 or (518) 745-4476 FUNERAL HOME: 115 ril.Kf _ RETURN TIME: DATE B TIME REMAINS ARRIVED ATCREMATORY! blalm 110M NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS: 916L rUAPQ HAMM: UM HAPWA CAE S TYPE OF CONTAINER: OPHUU 11�gt&M_Q PLACE OF DEATH: 1"F'1 MW NIRfW� TNHf II ESTIMATED WEIGHT OF REMAINS S CONTAINER i5Q ISw' PLACED IN HOLD: �1A PLACED IN REFRIGERATION: 1V7O en DATE OF CREMATION: bltTllo TIME STARTED: TVtM TIME COMPLETED'. 4•I619tl PLACED IN RETORT: _S M API MOVED: f RETORT P IN WHICH REMAINS WERE CREMATED: DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN AS HOURS FROM TIME OF ACCEPTED DELIVERY: NOTE:THE CREMATION ILO SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY. pNOF Mee 9m: NEWYORK Division of OM9pNOF<EMEIERIg opvomoruxln. aswa�w�2w a. . Cemeteries slower. Bala l RIA4246224i NowYki Authorization for Cremation and Disposition This Autlwr on Form must Le comment and Blpnee prior to eelHary of reeds load for crema0on. orb..Jura 22.2020 Number —je 7s3 Caanalcry Name Pone Y Cremai Mies, 21 Quaker Road,Comments, NY 128M per. e_ 518-T45dol CRE MN IS AN IRREVERSIBLE AND FINAL PROCESS. Chromen b limed M Ov ending Me remains of Met sed and be wMBber holding fled rbnalns I=atl melon chanterµhom theyaresubµxledto InleneefanaM flame. Tile Fml and flame well lsolnerab and wwume swimming mcapt beds and Ms 1. which an all am will be lad after Mora . rmlovnrg uema4m.Me small fail take mewmble efforts b remarks,an of the remains and other random from me aemal chamber but sine minimal dust and residue will may be Ishbehmt TM cremnry vnu sema2ta ircitemel end raepn meterel ham Ne remains and lneiMemMl endforeign materiel will be elspoaed of eB reguirm by rew. Thommateremalnsmillbem AadcelN eulveflmdinbamall eiew eM plawd Imoaeealgneted cmniMrdum. Cmmabd Mmlmgenemllyam Wl"I undim sbpeefngmentlerscognbebeeasekoN ll " OPENING OF THE CONTAINER IDe crematory may only then Me wnMer indent the uncramumd human Mor limited coumamncea soon as in ronfnn th human remtlns am Eohvsndin module which Is not suitable for such as conmooMl armor usMk N: N monetary willr uim built Due remains be moved into a suitable coriblM bore it mcmi the remains, TMc iN ae niner or me tananr or removal of remains wed ha conducted before a wlnass a no fail he done In erlvap,cram all rim aspecl. OEM F CAMN OF OECFASEO Name of Nmeeae. Edna Henna Msnl Subs: VMownd teal Known Mdm 77M Sam Rome 40. HeMwd, NY 128M Pdm of.. FMHWeOn Nurslnt Room 184 Bmewev, Fort ETMrd, NY 12528 Sex: OM ©r Ate. 94 goo. 09/06/1925 on a omen:Diddool Eemetad M19M 150 Descdptlon of gakeummamer in whioo diseases All M dramorm Minimum Cremation Casket, Florence Casket Co. Cardboardlpine PERSON X CONTROL OF DISPOSITION (PwBM(s)MCd00`diamasif,, man ONE OF 1M l0. 91 I BmMb are the designated agent of OM deMe.M dxigMW In a will or smart instrument sxsub] WrsMnt b Public HWM Lora Sector 4422011. ��WJe hatle IloknbwkNte ba1Ne dereese executed a rkmMn Instrument camuantb Public Heats taw Sedlon 4201 or e wA common Mariana far Me tismosltlon of his or her remains and lines we May Pen ras)asking toned under Public Health Law SBCIbn4201 and hard the tltMb autMnae cremation note rearl ofM (lem6 M/IourmleoMMp to M tmeaaed Is as boo w' Edna Hanna DOS legRf(Bark. Coral Pop 1 W S Authorization for Cremation and Disposition Number 3 pit xarMmnl xdmben� oa.aiptiNA"shomang and egllNn mace dome mOlder 1. ApdwnOaegn ,nwrifmg Wr¢uanf to Pudic moan LawSroppor 1I31'. g. Tie Moral dopmenry to. The wniNrp oOmel pane[ 3. My amPhang child eight n today 0 age or Gibe[ A Awri parent S. Asow,wag sibling eighteen yea a of age or often, S. AIaerfaly appointed trader L May,pagra s)ingivicen"am OF age or older emitted to al in Me SSW and airdrome defeat in rekfhiip to Me demo .. a. A duly amemormO fiducary of Me OSMR'. B. A come Mend or mletive who has ewculM a written MMmenl Moral to P&hc x M Led Section 42019); 10. A Niel fill officer of a munly Or a PaoliA commemorator abnormal wmuanl m the Suffg=a Cwd PAdAdwe AM fee. Any Wher amend Na b Mail On behalf of the dandeard and who had,ydddded a wdW narrowing moment to Pubm Heats Law Samon 4201p1. eUU�Q'��fr�I.�fd MlMnngl (�ALre%arm Met the mody of nre n a¢M deals nit mnmin a PWM Not Pad, paver coal, RMo wimplent or 2dioaclFve Orv'W eM Melany wcM1 maMneMwMe nmov0d piormlMBmuNon of Nils AYMwIutlM Form. FeOuneb MMB gnel � matmn may mal in ham to Me emmemry and emmabry panonmf. �Ia fMtintNm suave me.ngiana 3mpmame A.Gilman avv moral Ge removal Of any Pemordl PmopM or OVM MNp N Yalta MMn any Mwn mining EeWx or any laTry member Of tlM mwa wi to paean. Pia V'Nw Cannel is nNnespuneiOlB br Me mmoval Otparsmal Mme M1[m Me mMairKK Or hom Menemeim of Me d0e0awd. PemOOilMmisaln lit ono II•.��((�,,Ma mmeIM all M das"W by Me cra om prom and cannot be rNMved affair ammetmn. � Wabmby auMomlze P,MV Cmmmq �M bcm iMe mimed of"de Wd. ni OFG0NAU mas Mmmr anMoriae its named Miami dMMmb provide,for delivery m and mma0on by an almmab channel Itdmmsd Mpaaary In Me opinion of Me furnrel dner and to amend and form b Pmvwe Ma Whyll mama and adi ms of adman cmmrt q. FMAL GiISPOBITION The palace mempromad M mmun the CPomaMd mmOim Of Me dewO¢ed Arn Me cmrmhom Is'. Name: M.6.Miover Funeral Home AMmss. 123 Main Shamir Arpord NY 136W Phome 51&7474 A The[remand random of deroased Mu be die Ofa Mlava. If bar any raven tie goal named added Name not am pcwsavl OfNe mmam Mail Pits V'nw Cincinnati y euNw¢Bd bdw pYlYela W tly romans m M 6, NnM Furst Home Omml taydeLvcy in nor by FNIls Mmail cannot Hanna Iv�a[v9 00S-169114 Hev.WR01 Pap 2 of Authoriution for Cremation and Disposition (Mina Wun .rNM MMiltll[mmamsam nW daiMW wOin 12o drys olamllauan. Pine View Crnnamry mry dpow Mme remains In Aft,vow,geo an uninnrireNri manrar, win as ey a[amnre. CREMATION CONTAINERNRN ( r ONE of me,nWowmp) An an W as Wad as a ideal W the vemmad remain ma men NnN M1om and h desu4ed sa follows Pays un'srsbM WI MNe um is W small W Hold the erdre uFneba lemems.an addNOnal n&d xnlemy may W uNtl for QJrvny. f M um a the yet Wrtllae IMb undMbnd land I no um'a purchased or olMwlse provided Pine aside Dromedary mil dace the order remain In dmruarrvno a nq4 npormy nminer W dNtuery.W m The AUNrorzN nForm wee crowded b/ gbphpkA Often was evecNed at M B. Kilmer Funerel Home Pruawown'rv�+w 82 greed" Too Ecri NY 12828 puswmimrere eM is armed by the Nnnel dlretlw es worries b ib exeudon u i hi received a cnnadal may of this Authorization Form. The mMon(s)Identified htlow Were Me pnwn(a) In conbal of dlpwM rn,who Oy signing MW Alancr4amn Fomh enamel W Me ec[uncyeM cbnalBlBreea al NalMomlatlon[onbiMdln Mb Augrerba . SlBnad arm22M day JUM .p 30 tlpoma(sl iM1alorpoln0 Dana Hanna 7R7W Si Rome ao, H.Nard. NY DMIE1 WITNESS: Shohame n.aYmm ��a��A .tatBJ�w mincerai QM4 Hann laraesp OO flgS1(Rev. IN2l) Pps3afJ