Whible, Aubrey Lynn Pine View Cemetery & Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: v ylorit RETURN TIME:
DATE B TIME REMAINS ARRIVED AT CREMATORY: YININI 2,SDm
NAME OF FUNERAL DIRECTOR OR REDRISTERED RESIDENT DELIVERING REMAINS: 1
Kvc[ 1r�KuNa2 -lamn
NAME: PJBCEy IIxM. CASE At o
TYPE OF CONTAINER: _ IIwq cobt
PLACE OF DEATH: G J r4i lklt%l
ESTIMATED WEIGHT OF REMAINS S CONTAINER p $ (le
PLACED IN HOLD: 2:W T�
PLACED IN REFRIGERATION: _-Wjqk
DATE OF CREMATION: _ 0 17D qw
TIME STARTED: 2:ggq„ TIME COMPLETED: 4OR1 pW
PLACED IN RETORT: WCO MOVED:
RETORT P IN WHICH REMAINS WERE CREMATED: flaig
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL BE RETAINER IN THE PERMANENT FILE OF THE CREMATORY.
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Authorization /or Cremation and Olsposihon
This Auu zW on Form must as rompleletl and signed prior m deMery of remanns,for cm40n.
r fo Dow June 25,2000 Number
av
Cmnakry Name Pine MI Cremabry
M mM,31 Quaker goal Oueambury, NY 121 From 5167I544]]
CREMTTION O AN IRREVERSIBLE AND FNUL PROCESS.
C her soon'b*wined Out by olearg Me remains m9te dec and pen imr holding Ina remains into a cremation chamber where
May em suEJ$Md b Irxeme heat and flame. The meet area Mane will ImNnerab and mmume everything wwMA bore and mql.µMace am all Mat will eve left after cremation.
Following champion, Me Carl Mall take mawnade BMaM M immune or Of"remains and Other maWmi From the ucmati0n
MamMo butµma minimal dust and residue will likely be bo behind. Thecrematorymillsapa2 im,deMaland IwmignmakN@om
the remains and the incidental and Mean m9ell all hedi¢pyed Was rtOuiRd by lax. Theuema remainswillbemxan121N
dulvandsingle ad into small pieces and placed into a designated conblmra wn. hemmtadmmalneg mllyanpuNerUWuWlno
a Fragment Is recognizable as MAI famous.
OPEN NG OF FTN .CMMFUR
TMCRmaWry may only open Me mMainer holding Me umammehd human remains in limited unaccustomed such m mmnNm lher
irenotyol pedecesaed or t0 enwra Mat no small l¢mdtl µLIT might inlure employees or damage the crematory p"( IF
h union all Ins are activated i n a conM1imr which b not suitable forcemalmn such as ceremonial or all cas but.the
maWry will require Mat the remains be mould Into a suitable Panamanian before itacmpb Me remains. iho opening W a cmbM"oMe banskrw removal of nervous kill M wnducled Name awimem and will be done in pdvmy win tlgnhy am respct
IDENTIFICATION pF DECFASEO
Name W mtt$s Aubrey Lynn Whole Navm M N
Manlel$bma:
Lest Knwm gdUre¢e
Place W Death: Glans Fells Hchipt
sex: CM El Age:¢ul rem Goa N/A MWdt M.Uerza¢Uto Mmoame bap, Bibs
M9 W"OfA3 a mM iner In MliT mmalne art delivered.
Minimum Cremation Casket, Florence Casket Co. Cardboardflame
ffifil Ix IQ III po2Op�I
(Ne tin)in must W smairlem.sol ONE of that M1W wo
I whose aR thedesignated agent Of dw demaxed desgnabd I n a All W earken mabumeM ex WpursmNWPWlic
xe.nm Law seclion 4201.
Ip 0�10
"Wl IMy hose no MOwled w Me Sa disposed executed a written Imoumem punwntM Public xeaM Law aetllon 4101 Ora
will wmsimng dh mOm An the dwrOsm an W he Or her remoins and Mwe may Me must having pacing under Publk xee1M law,
season4201 aM haw the hire to script mmaHon more remains Ot Med a¢ed. WMurmlaMmhlptothedependisas
bllo
Aubrey Lynn Whible
DGstagd-I(Ray. gads)
Peg91 W
Authorization for Cremation and Disposition
(Ina&lfiwnflm HelaeWwf
Number; Oescrsofmn'. A9urvnirq parent
1. A insert dominated in wnhng Wmuant to Public Heats Law Seryon Anl(3).
U. YM sumving dommtic partner;
A Any surviving tAild egMeen"am of age Or olderI
0. A aurvtving parent;
S. A Nrvtving sibling sgmeen yeah of age or older;
B. A newlully appointed guardan:
T. Prey pecan(6(eynleen years of age Of under entitled he Mare in Me ea and who imme dosed In rela4onship to Me decreased
8. A duty eppolMea fiduciary of Me estate;
S. Aclose friend or relative"ahas eaemnea a affirm satement pursuam to Public Health Law Sal 4201
10, Achief fiscal ofcar M a counrym a public adminumlO appunWd pursuant to the Sumpem's Co,n pmgaure MA;
10I Arty ones person who is aping on bealt of to deceasedfits who has 0ewted a wnllen statement pursuant m Mal HWM
Law Sewon 4201p).
(Will ALL THREE of Me blbwmIN
LAW hereby affirm Mn Me body of has dagesad Mau M crntem a betlery, battery pad, power sell, realoetlre Implem.
or mdoarews Mi and Mat any such materials were narrowed peer M Me Oxe 'On of My Authorization Fmm. Fellu emu
Meu Items prior emmabm my mud in arm by tln cmm orry and barrel pareons".
INA affirm Mail lm Mom eve been given A Kyb Kfmm
regarding the removal of any personal pepeay,or other Mina of value when a my person mining bell or arty army rrenWr of the
Mmasnl wishes to real Pane Vlex Cremabry
ro...uryxa.t
¢notrescenslble br Me remwalINcersonel lmmBM1an Me wmainer orhwn Meremeim oftlw tlaa3eaed. PBnwellbma lehln Ns
ConblmrorwlM Me remains sell bay destroyed by Me cn "on procerm and cannot be MMmmd alNrcmnamn.
Wi Mal beauty authodv Pine View Crematory
¢ ury b anal Ne remains of Me axemed.
(Inal OFTIONAL)
ben hereby au hoam the fumed funeral Elncbr to provide for delleary b and OremaYon by an tlbmeA
cmmlt0q. dsemea necessary In Me opinion of Me Nneral director,and to amend this farm Me proven Me Co nal name and
addma of such atlemi crematory.
FINAL OISPWINON
Try cersrn eWderful he rexiwe tM cemafed remains of Me accursed Min Me aemetory is
Name: M 8. arm, FmwdI Home ♦�
pdd�. 82&eaaway Fort Edward, NY ii'Y Phase M&W9266
The IXem remain of dam wgl he OWi of as folwn'.
Rebeeea b Mal Call
If be any reef this Arson namra aWve does My table pommsion ad the a aW remaes,
Pine View Cemetmy, is mMv to a"comparison of
Malawi
NeedMe remains to M S. Ninner Furerel Home bydeliwry
to Porten of by nap lmall. Aid"Lynn All
00&l6 f(Rm, ali 1nw�ra Pliffil
AuthOrin on for Cremation and Disposition
QgMidmemwwrnat
MASS uMmraw Mat if the remarna are not naima wlNm 120 days M creme W n,
wine view cremmory
mpec,mmr may appose Of the ramunsm
an irreMevmlem.nrer, aaab.a by acetMnrq.
MCC& OH Cpp)AINE �
�aI ONE W MM(dbwhq)e
An urn to to used as a container Mthe crMMymm remaNa has dean purtli Sam
mw'n desmi as follows
IMle undernand Mat it Me um k am grail b hold Me of cmmadd Blnaina. an Seoul NO mMJMer my W uxtl Me derrvery.
-0R-
Inw—M um b M MpuMe IM4 and Wd Met It no um h VurfJimed or Mrawisa provldad
Pine View CremaNry
myvy�.h vnll pled the uemalq raneiM in
I NO dmNorary cmlaim r for fthr
The Awesomeness Form xw pro Wad py KYIs ICbner Wad erecuk at
M.B. Kinser FuwM Honda d..+rnv..wr
I# "thavy. FM EdxaN. NY 1H28 mmemwy
and In&1W May fifft director as w to Its eeenutldnrm�e
LWe have Seemed a awnplatM was,of tnla AVUro 8h Form.
The pamonppdentlfied Ebbw Wan Me pn s)In central a dMMaldon,whoby a MAN this AuMwzaO Form, 2r qn)
to Me awu racy and cpnpNYMss or B Mbmretlan Mnei and I n MIS AUMOd,,Mw Form a Oldauthoruetet the"alnp.
Signed MIS 2!M day ar June m 20
0n CMI
A
cry it
W EB3:
Kyle warm
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Aubrey Lynn MAIMS
oosteesr lidev, Barmy PetlasdB