Mann, Phyllis M Pine View Cemetery & Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: $S.Q _ RETURN TIME:
DATE IS TIME REMAINS ARRIVED AT CREMATORY: LIST Ilb I g67
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
1I
WEPDN .1 gJL
NAME: DA11W MAO CASE -I48
TYPE OF CONTAINEW (�
PLACE OF DEATW 3S y 1 g' ]pO /rtiy, I7�y�
ESTIMATED WEIGHT OF REMAINS & CONTAINER Ii l lit
PLACED IN HOLD: I'Mfh
PLACED IN REFRIGERATION: I
DATE OF CREMATION: _ YM.
TIME STARTED: Vr4M TIME COMPLETED:
PLACED IN RETORT: Z 6pP MOVED: �: 6D PP7 g: )0
RETORT A IN WHICH REMAINS WERE CREMATED: -W A.I &
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SMALL BE RETUNED M THE PERMANENT FLL[ OF THE CREMATORY.
New VOM stem,
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Cemeteries Lowell
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AQtAorBation for Cremation and Disposition
Tn4 auMorluBan Form must W campNbtl and sgmE poor W MlNen of nmalna for cm a .
oak OBI23I2020 NlanMr ALB
cmmaul Nannalone Vrew CMMWHUm
Radial Quaker Road, Queensbury NY 12804 plum: (518) 7461
CREMATION IS WI NiREVEBBIBLE AND FINAL PROCE88.
GBrMtionm waned CN by Peel the nmeird sides d%sased and nw W daing hiding the renalM Imo a cremation chamberwlme
Saw ere subjected to Intense held and Aame. The hart and term will McNe and censuma gambling except bons and malal,
which an all Met will WIle after emn on.
FWOwirp cremation, be uematory tell Wks reasonable etbns to remove all MNe remains ano One,m de al from Me cremaOcn
chaml bul sorbs minimal duldaM mvdue mll likely be lM Whod. The min Wm Mil sommin coming and foreign matenal born
therameimand McIncldental godbreign MSWal willWdip derogates bylaw Tg cremated RmainBwill be metlHninlly
reformed into small Rectim and placedlinto a deagnated annual go Cramabdmminsgamrallyam Wlv°daaduMino
single fmgmeM 4 e modr udi As skeletal tlmm.
OPENING OF THE CONTAMER
The currency may only open the container holding lee unuemMed human remains In Molted circumstances. such er to xnfiml the
k arc1y&Me deceased ma maure Met no mabr4l 'a enclosed which might Injure employers or damage the cmmatory gCRny. H
human remains are deliveredIna contalmrwh4n 4 na suitable for mmMmn such as control or mrrtal askµ Ms
cerebral Mine°v mamumrer or
Mmamoralral l d ranIars will ha Ireµaeans m b.fficmahootbsfarax.cmph M. rem.im. retienpenlrgas
a wdmM and will Iw Moral pi win digniy and respect.
IDENTIFICATION OF DECEASED
Name of Decimal: Phyllis M. Mann Muita State: Widowed
Lan MI Ahmed 39 Longview Drive. Apt 200, Queensbury, NY 12804
P4.re W Dego• 39 LoWinew Drive, Apt 200, Queerlsbury, NY 12904
set GM ® F Age: 93 WI ; 1W1011928 Dapdp 06/21/202g Eatl wwgm: I91
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1�\L�111 \Ll u,S (-5x Cyvr.4. A l �%f lAY a45A'
P N IN CONTROL OF DODOS ON
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I arruWa are,Me dngnated agate of She demised dmpmted In a MII orsinger instrument amculM Wmuerlt W PANIC
HmM law Section 4201.
e Nven0know MaltMdM eKK sw ninsmmem pursual Public begin Law Sector,4201 ora
wl ring diredilom for Me disposal of his or her mmalnsate 1M are Me pelmets)nal mil under Rude Hmun Law
section4201atehave Meremma him erematnNtmremalm WMedemaead. Myrour Mia hfpWMadammW4m
follows:
Phyllis M. Mann
DW 189"(Rev. Nii Page 1 of 3
Authorization for Cremation and Disposition
(Naen hem the lM bebw)
Number. 3 Deamipum: Daughter
1. A power JeagruW in wheiry punueM b Pudic Hidden tw Bectlm 401(8):
2. The sunrvirq Appeal
U. TM wrvlWp gametic pNrer,
3. Any aurvinrytliit eighteen wave d age or cider.
A AMurvNbg parend
0. A Annetta well eghteen"am o Age or aNr:
S. A lawfully Appointed Suardhon;
T, AM Cwao^(a Alignnmet Yews of pe or older eO to eon in Me eWd Anne who iwate comars maiomhlp m Na ftme :
8. A duty opponte00oumary of Me east
B. Atlme Mend or nal who has eveWM a wMlen statement punuent N RAW Heats Use$ecrn<201fT1:
10. A child hcel atAar of a eouMY or a publ'"claidwindor assumed Poo l ro the Mode re's Court Pr¢a1ae Act
ioa. Any seer perton who is Acting an benan of the decrease and wto nee executed a Allen ablenrem punuem b PWIC 1b0M
Law wdAdn 4201l71.
t�TTHREE&Me.mWomeiy
� — tons heMry affirm AM the body,of the demawd does not contain a battery, be1Nry p%N, power fall, Mode rve Implant,
or retlioamwtlevice and Mad arty such materiels were Assume p^orta Ne etfoorOM WMb Autlrodaa Form, Failurebmm"O
MMa Um prW tocnmation may Molt In harm to Me CRmwory Arai era gMmn .
WKMe ethers thdlnsOYctons lawn open given to W�dM. Bulicb
reOaNing the removal Many pereanel Model or other Mhq W MFro sal my phonon deice hMox or Any body m✓sper 0 the
domed wiahM to preserve. Pine View Crematonum
is not reamnaide ho Me hall mfpmAwAI Items ficn the mnteiner orhwn Me remains MtM Museum PamomiMm iAinMe
c nnumMerorcone Maremain.wabAWAbopdbymAcr flonpm "SaM"Mn bramrlaved Ateraremelion.
NY11' \ cone hanky authorities Plna Yew Crematorium
ro�wr w
m maned the rem.:M d ma awM.e.
Inftf OPTIONAL)
LM hereby Authorize Me name Nnarel dlrMtq to MovMe forts it b and cnmahon by an ahemete
consul H domed nMMMry In the Whom ofthe FuMM dirMbr,and As amend this form to provide the correct name and
Wads of such altamata CMMMM.
FINAL DIBPOBmON
no More Authorized to Amin the ovemeb]rxreme M Me dogged han Me vemetay is
N.M.:Singleton Sullivan Potter Funeral Home
Mere.:: der Bey Road, Dueendbury, NY 12804 pswe: (518)1g3id59
lM asoNd obtain&MOooeMwll be Wa Mm blbM:
Realm to family
If my weapon Na Mrem named ebom MM not rate paewNM doe oemeM r ft.
Pine Yew Crematorium is annbbdbglo pueWond
e
barrel Singlngletonton S Sullivan Polder Poneral Home MMaMry
v++vrewrw.d
In Moon or%rwiwred twl. plryilla M. Who
0O5181W(Rev. 01R0) Issal d3
Authorixadon for Cremation and Disposition
Mwkw)
�anx�nawrcmeme memnmwimeew inl2Oaeya&m.mmn.
Pine View Crematonurre mgdaWee WMereeelroln
an ineneeba manner. was ee W aoamvrg.
sn
G ONE or the moment)
Singleton Sullivan Potter
M um to M use]an a wmsiner M lM v homes the been punts hartc ....
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and is aescnbeb as more:
Whose understand am ntle um is too xnll W nod therm n c r me ed reforms an ackdtknal rqb camner my wM for d.0.vy.
ns-
M Veer MrMyV PFMVYd. IM's uMeNBM Net tl m um b WrCleaN aollNrxiae gavi]e]
Pine View Crematorium WO pace the cement remelnsin
ao�xmn
a eight Montserrat Container for delivery, mrs
This Authorization Forma prwtded My Wendy M. Bulich was overused at
liana
Singleton Sull'tven Pager Furteml Florna
407 Bey Roaq Queansbury, NY 12804
and is elpma by BV honest director as whereas 0 by anamon w.w
IM1Ne have reeeoed a wmgeletl wpy or the Authartretion Form.
Then onb)IdanYaad Mobs,homes pareanb)In conaol MdaposXlon,who W signing Min Authorization Form, aneds)
b aN NCarNy eM aompbtanns of has information Conblmd In Ma AUMozeness Form and aumorize(s) Me Ro poing
Shed Mb 2Md day of June ego 20 1 , .
Patricia Mann �ggji.—, �/� NN`�
375 SouM End Ave, New York, NY 102
IRS—
sooner
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MTFHE88: I
Wendy M. Bunch
a a.a.+rw�arweWe
10441
Phyllis M. Mann
wars so
DM188br(Rev. 0arz0) Pines 3 cl