Palmer, Dorothy Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: T DA D4.5APne.I �RRETURN TIME: �2
DATE S TIME REMAINS ARRIVED AT CREMATORY: d - ,, 27-jaw
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS: -
S
NAME: j)ptd-IL. P¢1/H!r , / CASE�S '779
TYPE OF CONTAINER�10(>"b/n.i����+1 yl.ie /'e tA'/er XA4C. /'AT N
PLACE OF DEATH: 61e„5 FS //4 /A2T k4. aeCLA 511724)p1
ESTIMATED WEIGHT OF REMAINS S CONTAINER 4`b IAA.
PLACED IN HOLD: N4
PLACED IN REFRIGERATION: i✓/Q
DATE OF CREMATION: 1'/7,9v O
TIME STARTED: A�J-- TIME COMgPLETINGp1011-
PLACED IN RETORT: Sir— MOVED:
RETORT A IN WHICH REMAINS WERE CREMATED: 116deI Qk LL
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 45 HOURS
FROM TIME OF ACCEPTED DELIVERY: _,
NOTE THE CREMATION LOG EHPu BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
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Authorization for Cremation and Disposition
This Austronesian Form Milt bs COMp and signed wren 0 smaller of remains for Cremation.
Deal 06126=20
CremeM Name PirM YWw Crematorium
mareu:51 Quaker Road Dueeresbury NY 12804 Phone: (518)]45-047]
CREMATION 15 AN IRREVERSIBLE AND FINAL PROGESS.
Cremation is carved last by placing Me remains of the ae0.V9N and thas rer propose the remain into a uameAM chamber all
they are winners to intense beat and flame. TM heat and l will splash are[WWM ewerthing ea[epl hero are m 1,
Which an all"Will b r NB after Czwnages.
bringing excellent Me cremally all Wile responses seem W remove aII W the remain s and other maknal horn Me Western
chamber, bill wme minimal dust and residue WII b ere Me lalt behind The clemabry will summers iroldental and all maternal M1pn
Me remains and Me lnodental and foreign mineral will N communist of as required by law. The uemeted remains will N traditionallypulamed,,nWsmellpensareplawdinbadeaigMtMWMlworum. Onmatedamain¢grumllyampulver u"Ino
single fmgmrd is rropotrlMa as abalN l Huue.
OPENING OF THE CONTAINER
The oemabry may only open Me apparent bidding Me Lincolnwood human aluminum limited tlrtumMims, such as to onfirm May
ure
ees or
mage Me channel propers,
ads" he chnignamend or
are afllvnWnIna onWinr"hk nosuiUblefor'[mminitlon suchyscommonW H immMican ,t
�nmaber will Uapu Mr Me name ba moved IMo a au W [ontainer b ap IIW do 4n nmalrn. TM opening W a
pnWinerpr she VaNree nr renal¢a amain[w;u he WndpcMd be«e.wiener am win a dare M pnvncy, wed digntty aria rupee.
nENOFICATION OF DECEASE°
Name 0° an : Dotal Palmer MCMee$latlp DIVIXCad
uN Nrmm Address:2 Bluebird Teeal Fort Etlwsrd, NY 12828
phcr of peer,Glans Falls Hospital, 100 Park Street. Glans Fells, NY 12801
See OM ®F Age: 77 DOB: 0511711943 pm dues: 06,12ME120 EsgrreWO wmft
abspIMm of ae o«tainer In which remains will bedekwrMl.
Fiberboardlaltemabour container, McNhews Company
PERSON IN CIXITNOL OF OMI InON
(Pwso+(S)In antra mdrspw,iebn. from,ONE of the Mb..irq)
1 emWe are Me anagotM agent of Me de designated In a will or wn brnment secured pu ull W Public
F M law gevEat 4201.
-OR-
AWD Ise hre no knowledge that Ms decrease evs W a wipes Instrument punwm to Public Heats Law Section 4201 on
will CopaWmg directions for Me research of his r her remain and INre are Me permn(s)hriy prioMy under Public Anoth Law
Se 42019a Mvetherighttoau naemaeondMeremainsofinedmaua. MOurmib shepWMe MceasesbM
Mlwn:
Dorothy Palmer
sai
DOS-18981(Re, 04V20) Paget of
Authorization for Cremation and Disposition
final room the Feet row)
Number It3 Dasoiptbn'. Surviving child
1. Apmmh deagnelN In wring pursuing to Public HeaM 4e anchor 4201 i3p
2. Tn sure spouse:
A. TK surulNiq domestic partner
3. My subhong di egl nyeah of any or older
l Asure ip parent
5. Asuravi 0siblig eighteen start of age m older:
6. Almormy appointed gun inn:
]. My person(sl egimen sees of age or older cement to share In Me estate and wM mmmr dose&in matvubip to Me deuabdl
a. A duty appointed fidunal of the estate
9. A done friend or neiram error has execuba a wrMeo stsement compact In Pump Health ban Section 4211111
10. A thief fW9 l officer of a county or a public edra ierator aµ'GMed pursuant to the Sumgate'a Come Pmretlue Act
ham. Any other parch who is itin9 On MMM Of the demesed and who has()(mated a wMkn statement purni to Public Health
ban SectbM2ol(71
rzoldALL 771REE or the bllaving)
NdY INie Mnby 61firm 1MttbeCWr of Me aema2ed awrnM eoMeinabatlen. bBtkry pad. Y+war xll, richox9velmplant,
arrtlloactive tlerice and thatany suclhrretefieb wart removetlpw to Me emcNnn NINaAWFarlaatlon Form. Ftlluntonmoae
assay gbr to memanon may adds In harm tarn crenrpary and slwmatary p•raenrrel.
.� Wee ammh that reductions blow been Siren m SLmhhAA.r Philo
re0aNm9 Me removal 0 my peasonel pr gooche Mind of vNue which any partner signing Ixlw or any grocey thanker d the
elemental acmes M random. Pine View Crematonum
in not reapproul a roc the removal a prominent items nwn the consumer er ham Me remains Of Me aeme:ed, pwaonat Map left MMe
compete or win Me remains Fain be aeaboyad by Me commerce pr«ua and on not be min Mar cremate.
uwa herby somomze Pine View Crematonum
acre w has nmelm Of Me aecsosad.
Dvn Na )
IMe .r.br marl tn.m tar el p Ns na m n an
, rid asap pationof haddhom , amaman for geoid.M•Oomct n. ne
MaanIn .m creme
F N" Mff"OSMON
lee l'<rron promised W art Me vemebd remains of may anneal foam Me anmMaryi&
come:Regan Danny StalbN Funeral Home Sarah A Pi
Marina 53 Quaker Road, Queensbury, NY 128M mum: (618) 792-1114
The conamands remYna of drweaed win the aYpel a w falews:
To be redo eel ro son Georg Palmer
Itb any reason Ge prrmn tanned abare tlou rot and pcaxasan OF me Co mtll apparel
Pine View Crematorium b amhpevd m troy conaadan of
l"Famin,Ni
Me remeimm Reg n Denny Su=Pd Funeral Home by dlvery
in person Or tor mpieareel man. Dorothy Fineman
Authorization for Cremation and Disposition
rnfo+ u�a rdb»Ynv
�rX4j Me understand that it remains are nMWImeE wohin 1M day of Mmadon
Pine View Crematonum mar dispose w Me amass in
an imavonsabb manner.axn as by xetreme.
CREWIgX LOWAINERIORX
(n ONE mtlre idrarvi
Regan Denny Stanford Funeral
M um to be ubd as a conbirer for the vemedd mmbn may been quchaeetl han u_.,,_
and as descrW as broad
WIe uncommon that it no urn is too small to nde the for oemabi r M.an M Wmi ond¢nfa' MY In used brdsevery.
.0F?-
MumIsmtyet purchased. Meutlmbntl Met it no um is prW or oNervnse gvuNe!
Pine Vww Cremetonum mil plax Me oemeed nmaim in
dwmea cy
a ryk Nmryay mReiner for"M Y,.
Phis Auromatis ms Form wady amaaed by Sarah A. Phib what executed of
maw bor*r, +�
Regan Denny Stal Funeral Home
53 Quaker Road,QuYd nsli NY 12804
.�
end '6 all th Me Nneral formal as small b its execution
lN/e ham,reCBNed a xmpkted wpy of Or is AuM Zarbn Form.
no prawns) idenMad below Islam"wma l In eonwl of dapmldon,who by afenlnR this Autlrorlaaean Form, atbeega)
a ere maumeyera carnplabnms Mtha information mnuir In the AulhatraUM Form and authorial tM aRpoing.
thonse Mb 2611n day of June .20 210
George L. Palmer
33 E. Tremont Street, Glens Falls, NY 12801-
ABC--
SorshA Phib
rwa 12869
D2=Y Palmer
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