Downing, George (2) Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERALNOME _ __CAf�p WWE RETURN TIME:
DATE A TIME REMAINS ARRIVED AT CREMATORY: Walm Q"La1
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
bum ftzcQs
NAME: CEQCG IAUAITN CASES 70
TYPE OF CONTAINER: &Qmm pj - WO CM&
PLACE OF DEATH: Z1 H Ad Qg�l [ IIw IIC3 )
ESTIMATED WEIGHT OF REMAINS 6 CONTAINER IC6' I&r
PLACED IN HOLD:
PLACED IN REFRIGERATION: 36
DATE OF CREMATION: (I I26�
TIME STARTED: _ 1:ZDAe'I1 TIME COMPLETED: ID- Is"
PLACED IN RETORT: 7:3BAn MOVED: RI VO pPI % 11.71IYI
RETORT If IN WHICH REMAINS WERE CREMATED: fiBs&&Va
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE:THE CREMATION LOG SHALL BE RETAINED PH THE PERMANENT FILE OF THE CREMATORY.
NairE' ORR Division of departmentorSte"d
oWMION OF CENETERI6
efuldo� one ce"wes Pea,
0 OppPPML"'^ Cemeteries plywaymermI.Avici
Twa :flea s
reamovervi
Authorization for Cremation and Disposition
This AU or orlon Form must to mmplY and sinned prlurb delivery of mmine twcm=Wn.
Deb: O N2020 Number'. 7S�
Crynelpy NYM. Min VNW gbcIeWY
AbAess: 210uaMr Rae], puBe q, NY 12E1 ppgge_ (510) 745J477
CRF11 MN IS AN IRREVERSIBLE AND FINAL PROCESS.
CAmAon is carrlad old by pleon9 Me ttmaiu Of My uxaee] and the container headed the remains into a aemum chamber serum
May are eubacbd landfall beat and flame. The but add Hama will incinmb and consume"try IN except bin and metal.
which are all dust will br aft after cremation.
Following colonel the crematory yell take reasonade etbrm to remove allot the remains and other material from He normal
chamber, bid some minimal dust and momewill likely[e led[etrundi The crematory will separate incedreartal and moral material hom
the remains and Me mouldier and breign m0ewll MII aw viscosed Ma reryired bylaw The uemabd remains MII be meNamolfy
pul"nd into small geceeaM paced irMadulgnaWmnrainerorum. CMma mmalmg MilyampulwM uM1Ino
single bedroom Is mmgniu ble as useful Useful.
OPENING OF THE CONTNNER
The vemater/may only Wen Me mM ,der bdding the unaemabv human remains in limited awmabmn..such as Wconfirm the
u oflets dewasW onto ensure Mat no material Is surgunv when mignt irjnreemPloyeea orNmape the minatory property. If
human remains are*$In M Ina contalnerwhlch N net suitable Mcmnatlon such an ceremonial pent WkK I
Carol will but Mat Me remains be moved Into a suitable container Were itaccepts Me mains. The geri of a
broader or may member or Pomwal of beer or all be unduded drum a witness and yell be drew m phwry,uh in dark add mmwct
DENTFICAT O"OF DECEASED
NemedM ae George Dwming Me=[Staturs Di+aad
Last lNwm AWress: 29H Avbggack Circe. Ganuvmn, NY IM31
Plain of Ni gall M,ro as Circle, Genarvmrl, NY 12931
hex: ®N OF Age: 63 we 03/30/1957 vita of Na , 0620frzG21) Emnvtedwbght rRS
Dworgaron ofmNMtandmer In MIIr minxes MII u d lw
Cardboard Box wlVJooden Base
PEBBOa M CONTROL OF WSPOSOION
marryd a)in mind PlutoNxin. ua &ONE orMe/dNtafnpf
Wi aT dre desgnate]adept ofne dewal destgnabd in a art or t n instrument ertMM percent to Pubic
He//]]alM Law Saclbn 4201.
ahIMN have no knowledge Met the W WN Waxi,nmtanut mrrsuanl to Public Health law Secion 4201 Of
win concerning ddectidns for Me dwW:Nan of his or Mreml I IMC am Me p n(s)having pt under Public HUIM now
handled 4201 and ava the right 0 au ebull mdrem mof Mad a� ay/Our mlNlbahlp In dp decamad Is as
follows:
George Downing
DOS lawf(Rev. MF[0) Page 1 of
Authorization for Cremation and Disposition
74;d Mim th NflOekw) "y l n
11.. TA m ndmn i dossgnn in wiling purmanIb Public Hl lure SpdOn QO1(J);
L. The Mu in tea me porter,
a nnv mrvlNy cnm matter,yearn of ape or aNr,
A. Asuri parent,
8. A Harmig sibling warfare aN Of no or cider',
a. A carefully e0pninlM guar man.
L Any person(a)Intel years of ago or Obis enE tO ohms In tip estate art wholalere m ant In remti0rsbip W MY EaRpieE;
8. A duly appointed flduGery of to emem',
S. A rase Mend Or remit Me, has exeabd awnlmn shipment inherent b Pul Heal law Sectuum@01(]),
18. Achad Ham O ear of a county or a ry0lic administrate,appointed pu¢uent M the Sumpate'3 Court Procedure Act
10s. Any other paalme p acting on benaB of Me der Sa and who haltveamd a musin Statement pursuant p Pudic Heel
laa Semlon 4201 g),
fl AALL THREE CI idea bNew y)
03DMay beral arm Met tlp any,of ids deemed deals net common a bNp ,battery pea, porn mu, rechannel implant
01 redioxNa dNm and tM1A any suN maymeas Map Manuel new as the execution of Na AUMOM ft Feel Follum W remove
d nn M ms prior to crampon may met In ham,W Me mmapry and CMM2wy"Monnel.
mbAft eMrm Mat lneWarss ham been given to ROIIeM G. ran
repaNing the remove)of any personal amount or otter Miry d vLw Much any person mining ENow or any mmitl member a tlw
deaawd wishes he preaave. %ne May Crematory
a net responsible for to Heal of personal item$Num the wrdaMer or TOM the remains of the de.'pawd. Penoml teams mN In Me
summer or with Me Hear lM will be dxboyM by Me cremationa nmew process and cannot ted Sb co n r m d c .
Ub left' hereby ouNONe Pirc Viex Cemaory
vMay
by cremate the remin ,of the dxmed.
LI(NPTIONAL)
INre hereby M thmae the named Hea l director to provide ear delivery ton 1pm and cnsill by an aato
a—tort'. If aemed necessary In to opinion aMe yni director.and y amend this by provide Maomctn.m.and
arnnddm"a such alternate crematory.
FINAL DISPOSITION
The person anthi el W MCI to aemapd remain of to deceased from dp c Mon is
Nerve: Constitutional FurealC
nedresa: 40R Maple Ave., Sar 8 Son gs W 12M per. (Ste)ssol
The Mara l Heal Of deMaxd MR be dispweE a es fatty:
RETURN TO FAMILY
User eon mean the wroth nYMl mVon At MY mM perinea a me tie remains,
pnoVi Cianayry 'a adha to pre you OF
Me remains Conga" MFUMRI Care.Inc of dismry
in canon or by registered me8. pneeromrvnn Ducrya peenlrg
DO$ 15g&f(How Il earn Pie 2 on
Authorization for Cremation and Disposition
r�¢s�a�iM roxnwby
Mi Ilk general MM if to remains are nut clalmeO whin 120 days of uerston,
Ran New formal may dispose 0l no,May'll In
Mmmuow
an lrrebkvaek manner suit as by somannp.
CREMAT ON CONTAINERNRN
Nmma ONE dine ldlomi
M ambmad M as a container M the uemabtl msiro KS Mn Wml Mare
BM blSGlle Bs klbws'.
IM1W ulnsdl Nrt N We um b WO amtll m Md are gran vemebe remam%an N] al NO IXnraiMr may Muses OF Wieary.
orbM um is mr pr migration IMP gMrsnl Mer it no an is NOU noGerwue prrntlN
Pram Neu Crematory and pon the vemand remains In
a NO smponn Rainer ld eeavery mamretrvnosl
This AYM w Form was prmided 4 Fill G. HOp was Wagner at
COmpn040nM Fureml Can. Ins
402 Made Ave_ Sanlrya SO IIFd pnl W 9
arms "go!mthe mml director as wM1resa to Iexacudon��N
mub hen nnred a mnpWi copy of Me Au~zr on Form.
TMp n(S)lM ed OMox INen to PonOds)In conbol of dlspniWn,who by signing beer Amnodae towns,a ge)
btlre eccunry and impMhmas dMs LNonnWon contained In MN AWnodntln Farm and eNhorlONe)ureleggoltq.
Slgnas Nis 13ta dayd .10 E0 ^ \
Ross W on behalf Olde]hRf San Powniig rtlaugMerl O
79 Crescents fa al Samoan, Ny 12M
goal
hnsr„v %,, miss
WITNESS: min
Rolland G. Maing
w 11LK nM
t awn GwOa�W
yoannesann
WSMai-frRay. I Pagi