Heidrich, Emily J. Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (5I8) 7454478
FUNERAL HOME: _ . .. _4<� RETURN TIME: IANL OL,
DATE S TIME REMAINS ARRIVED AT CREMATORY: IOI z9y *
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
nTcuLau wlarn
NAME: EA7L4 hypg ( LASER _74
TYPE OF CONTAINER: 1•Yy '''��,��uu::yCCC
PLACE OF DEATH: I amI'uFll'
ESTIMATED WEIGHT OF REMAINS A CONTAINER IIDdF
PLACED IN HOLD:
PLACED IN REFRIGERATION: I
DATE OF CREMATION: V /IT IZD
TIME STARTED: 00An TIME COMPLETEDI I665An
PLACED IN RETORT: VfOAM MOVED: /0%ID An /W
RETORT S IN WHICH REMAINS WERE CREMATED: Sft RSJLFNK
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN AS HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL RE R"MMMI IN THE MINUUM [NT FILE OF ME CREMATORY.
NAnt Division of °NBpH OF CEMETERIES
sTATE°F
°`imill Cemeteries as We AWmw
]3mLm1
T.lea nv.IS,B4PHQAi
u M9w
Authorization for Cremation and Disposition
Tnls A9utlwtlnbon Farm must W complNM and egne0 Prior Nor delivery o(nm ns for Germans.
aJ DateJ � I / Num[er 'A6
Crewmen Name Pee Mew Cremakry
Address, Quaker Road.Oueensbury, NY 12B110 pain. 518-74444I7
CRENIATX3"IS AN IRREVERSIBLE AND FINAL PROCESS.
Oriental is caned cot by plating the remains of Has dwre6uh and tW container hi the renulns into a cremation Final wMre
my are subsiced to Intense heat and flame. The Imt aM flame will Incinerate and consume m ryNinB aaupt Intro ard n,arel,
which an all that will W IM after cremation.
seeking cremation,the crematory MH toss Sri HeeMns b remove all m Fee remains who ones matelot from ate crm t n
chamber, but Some minimal dust and residue will likely be left behind. This mwwOry Mil Separate intlderm and 10mign material hone
the remans and tee Inciaenbl and Harwell marmal Sall be disposed of as wall by law Nine cremated remems van be medmnimfly
pWwnaed Msmell peres and placedintro a designated container mum. emmab remalmpe llyarepulveriu ur ino
single fragment is recosnilable Am aN.Ieml wew.
OPENING OF THE CONTNNER
Tree crematorym ryonty open the container holding the umcremem human remain in limited circumstances such as No confirm the
member of commerce onto ensure thin no mMeual is enclosed whim might injure emplaymescolonels the minimal property
human remains are diagram! In a conMinerwhicn a nmsoltable for cremNon such as aamnonu,or nwna cash[the
crematory will require Nrt Ma remains W mmkd me a Suitable computer baron maccepbs Ma mains. TW opening of a
container or the tranear or nemavel el rerreens win W w dW Wbre awines;and win W done in immoy W0 dignity and meets.
IDENTIFICATION OF DECEASED 1I � I
Name ofDewmel: l'mt �`/ 1 144dri p Mantel Sans. mwi
cut Known Address: m person m.,a NY mark
Pla n�'
sea: OM ® F Age: -Il(��3
— DOB'. France DMa mCuth:� ai ao Estimated walift
Dastnpeon of raskeVDMamer M which remains Sin be dtliwer
MacLbroN WmMner basic carill uema ter cmaimT
PERSON X CONTROL OF DISPOSTONN CONTROL OF DISPOSTON
(Parecn(s)in xMrd ofdspavGon. yO'p'ONE aff re centre y
eMWe are are deeipmNN agent of tee dareaeed designatetl in a WN or sa fter InsLumem eveaad punuent to Public
Health law seaiT azm.
HOR-
WJe have no hnmmuck a that the dPmwNm command a adRen Instrument WrsuamNO Public Heafth Law Section 4ml on a
salt Wmeming diAtlVns for the discosibon of his or her remains and lw'e am Re pressures)lasing Primary under PUNm Health 18w
setlwl42p1 eM have Me ngM to eutnor¢e uametW of Me remain ofbw tlwYesed MyyOur nlatio erseco m deceaved u as
blbvn: Emily Hamill
D05-18W f Rise Pap 1 of]
Authorization for Cremation and Disposition
Cghjl the Annual
INYe undersUrgllut dge remains are not genie visher 120 days INaerrution.
Pine Vlew Cremabry may dispose of Me remaire in
punucnwwrl
an irrelrwvabh manner, such as W acaromM.
CREMGT ON CONTAMEPN0.N
(BONE Oft Mbwq)
emu.An an to Oe used ad a� ^
m'malnerI ^
he Me d onsurn anyone has Oren purcNaud ham Brswx m Funeral Home. Inc
gnat is des �criEed as hgs 1 Q � MZL,
INIe unacstand Mal RMe um is has small In MM the entire cremated Smash.an additional rgal container may Ee used M Nivay.
OR-
Pnum IecotyetpurcMaed. INJeundemtaMfttilneumis WrehasedaeMBM pmnded
PFaV LttmNwy well place the cremered remeNs in
a Ord temporary container for delieerY ix.,e,crt+mr
This Autlrorrsa0on Fonn was provided by PMnSa Miller was executed at
Brewer FYMral Hama, me, nwnaanwmi
24Chi 51., lake Lueame. NY 12M —
and is Signed by the Nneral dirMw as wllressM Its erernate
IPNn have mommd a ampl&ed easy of this AUNonzaNm Form.
The parwni Shanghai below hill Me Pane l8f in combat of dispcsiion.who by signing tie AYMomdsi Fans,aCatle)
W Me accuracy and compleM^�e¢ aNe Ingfomubon con wined In rhea Autlw mWn Farm and autlwizelef r Na forpoirrg.
signedthis ' 11 day )\a J AImir 2000 .
B'e�ran I-Fe.11pdrfch - Ppcindzn i � -
' outer Ct AI -amnnL 1 17fYX1
WITNESS:
rebioa Miller
12485
Emiy Heidiich
DOS-18W-f Cmi 08115) Page 3 d3
Authorization for Cremation and Disposition
(mail whom and My
3 daughter
Number Oesmptim:
1. A gason designated lowr'Nng purnmessi Public NeaM Lew SetlY Qo113f:
1. The pro mng spouse;
L. The wrnnng compete prmer:
3. My summing north eghteen yeah of age a clear;
0. Anormal parent
S. A surping sibling eighteen years d age or older',
S. A kxlulh sproirded guardian',
L Any Persons)aigM1lttn years of age or older eni to aM1are in the cause and who laws cowdel'al relationship b the de as ;
0. A duty appointed gdual of Me anal
S. A doss,Mend drelarad whom has execul a noted alati pursuant to Public Head, Law deal 421
10. A Proof fiscal dficar&a Wuery or a public adminislmlor accounted pursuant to the Surrogate s Court Prompted Ad:
10. Any other person who is acting on When Of the decresed add who mare Mail a written srelinent Mohamed to Pudic NeaM
Lax BMron 4201 m.
((paI�agA�(n THREE ofthe/ogaxlnp)
-7 M Mreby rearm Mat the body m Me eeuasM does not domain a baXsry, batlat whom. power cell. reeiwhat Implant.
or radmaarve device and that any arm materials were removed prior to Ise exedulicn o1 this auMortral Form. Faiwn to mncaa
Rine items prior W cramabon may mutt in Mrm b Me demabry and cremMory personnel.
--We Me affirm that Instructors Mend hand given to FeWcie Miler rary min
regarding Ma reemoval of any personal muder or brown Ming dwaWe whICM1 any person sgmnp belax or any hardly member of the
dX¢ased whines to preserve. Pine Vim Crem
le rid mpamidle br Me removal clgrsNel item¢hanIM wnlahxonc�mfM1e remains ailing dtVesee. p onali sl NIn Me
contained orwiM MB remains will Mdeeboyatl "a cmmtllod prc and unnMM reWevae star cr0matlan.
x IM'e hereby auNodn Pine Yew Unmoral
"wwwm
M measure Me remains of ome Masash .
FINAL OISP SMON
TM person arms ad to decade Me oareled remelre d the de Ba hcm Cs varulwyis,
Name: BrMer Funeral None, Inc. Wanganui
Morass 30 Church St. toes Lussme, NY 12B10 Pfxre. 510dW-2taa
TM cremated remains of aexewe Wu be diapesed dwe ofthei
remml lM
pkaCcnivnrL in 5t MnnA5 Onlumh2rllum
If b any sewn the parson ruined abuse does W Me possession 0Ue Mandl min na.
Pire`Aex emnalwy p su0maed to use pnaaessiond
m
Me remains to Braver Fureral Horns, ins, by delivery
hm.we�me.-r
in Mmn or by regislaed mail. [miN Newark
mah.✓pipm
M&10954gov, (di Page 2 d3