Grau, Sebastian Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: AD L'u"c RETURN TIME:
DATE S TIME REMAINS ARRIVED AT CREMATORY: -7Ieho q. WIM
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
1ODO 6 INCQ
NAME: 5EB};5'[ ? 6EAo IICARE a -211
M TYPE OF CONTAINER: FLr �1 Cyvw C ! i„A l .P
L(G PLACE OF DEATH: r f(Ati 46yi4s I
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER hD Iy /144-
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: -116I RI y�
TIME STARTED: I011}I AYI TIME COMPLETED: a L"!r1
PLACED IN RETORT: IMAh MOVED: IL1f A1'1 )I.�W II(o1: :
RETORT A IN WHICH REMAINS WERE CREMATED: 5`PM- P"-rHy
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE:THE CREnwrmH We SHALL BE RETUNED IN THE PERMANENT FILE OF THE CREMATORY.
SmScrKK pIVIS10R OF D.wrun.l�wst:e
LNENTAiEYF DMSIOH OF CMMRm1ESa
OPPoRIYHIiY. Cemeteries µy,Nrglnn<venue
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Authorization for Cremation and Disposition
This AaMerluaon Form mast La completed and eienea prbr to delivery of remains for clamal l
Dore Jah32030 Further'. 719
Cmmabry Name:Plm View County 1
Mdr 21 OwYsr Ford, Columbus. NY 12BOC pomns, 51M745LT
CREMATION IS AN IRREVERSIBLE AND FiN PROCESS.
Cremation is come] out Ey p1e6N Me remains Mine IIaS W and the container huhng the remains into a c erearbon crammer there
they am subjxtae to intense but and dome. The but and Memo will Iw ourab and wmume wmydM a we spt bmre and mMi,
which am all that will be left after continuum.
Following oemour,the crematory will take reuoMbb efforts to ranee g all 00 remains a nd other material from the atiem
tlWmEer, but come minimal dust and residue will Iikap be lam behind The mamatery will amounts InadenUl and Intel in must from
the remains and theIminumall and foreign material of be drerysedmad moms my law. The Gemated remains will be mecu ls)
palrerda ima small pie®a and Patttl mN a eesianated wnrairpp um. Cmm W mnalno gently an wNadue untl no
single mamem Is acoanal as sk b lasaue.
OPENING OF THE WANER
The mercury may only own the concomor Mlding the uncommon hums, remains In Nmiad cmumslen em such as to cal the
Moment Medical ortm ensure that no summer is endosM which might Injure employee assume for cremstorypmwM. If
human remains arc delivered In a comtlnar whim Is not module for cremation small An u mamal or rental casket,the
ishummudy will rwuw tutue remains no mood Iran a emhble container will N accepts the remains. Traowmng orc
wnmeder or try transfer or removal of remains art co condumed sabre a witness and will be dome In rural with fill and retied.
IOENTFICATION OF OECEexED
Name of usual mbaMw Gmu Metal Sties: Never MmdM
Lest Known Accrues: 10 Augmb Wive.Unit 10.Vernon, NJ 07at2
Pam of4M'. Glenn Fells Nwpsys. PHk Stread Well Falb, NY 12401
Sea: OM OF No 19 Goa'. 04/16/2001 Dam Noeag,,07MMON Esgmead WHaht 120
oesmptpn of cwwVuni in which remains AS he Manor
Minimum Cremation Casket, Florence Casket Co. CandboardlPine
PERSON IN CONTROL OF DISPOSITION
lPnmwf»mronedoldlspoemcn. mltm WNEdme mbxnal
I8m arethedearenisimeantof111e.Muddesigneesma Mloru nImhum nteawm0dp moMmPublic
Heann Uw Secdom 4201.
OR.
�i : W hawewknewkllwlhalceaMeeedem dawntanln&mmenl Nmuenite Public Heats Law Setlioni2ol ora
l� wll conducing consumers for Me depwitlor.of his or her remains and had are the wrtonlef haNrp phedly under Public Nemlh Low
Sec0.n will and have Me yMb authcrme curl oftg remains Mtte model WMurnaticnshiptithedec"e sae
helium'.
Sebastian Gran
OOS-ISebf(Rem mil paw 1 of 3
Authorization for Cremation and Disposition
gamadmen meaodabwf
Number Deaulpand : A SuMvinpimmnl
1. AFam" gp W in wriong punuen110 rude Heats LewG 1(3y Seom4 ,
P. Tins surviving spouse',
b. The Offering dommtic pmMBr
3. Any surviving cold egb0.n"am of age ar offer
A AsurviOnl parent
S. A current 901irg aigMmn years Of aw or older.
G. Alewlully appointed guardian:
T. Any penmm)agrees years of ape or Older molted b avers In the estate and wM'WVe dxesl in relationship b Ma Maagd;
a. A duty appointed eduaary Of 00 eafde,
a. A Wm friend or mi who hasexesfW awhomsegment purchase b Public feel Law Swoon 4201m)',
to. AWait ne®I olfimr M a WUMy or a glom mdmimahalm appoined pureuanl b the sunceral a Com PlaWure Ado:
iw. My otlKK person Me la mel on behalf Of me d sre and And has executed a written Mb oM pummM m PWJw HNIm
Lux Section Qghr).
(jai ALL THREE 0 bay @4 g)
A
_t`IMb haraby efirm Mat Me bMy of rile dweeaed aM At mnlam a damry b "Wtlt poser call, radloaC4W Impkm,
Or=iO=IlW tlniw and Mat any such mffidala ugre remowO prone the execution cf Mis Aulbvha nFwm. FallursbmmoW
Meu Items MHOr W mmatlon may result In hem b me crematory and nemaWry"e nml.
G6 INA oMrm that lnstruNms Nve been given by Told G. Kumar
X'\ hassumif Ma rmmoval 0f any caramel prcgM or o Meng al value whi any parson agning bows or arty family member 0 Me
deuamd wishes S,premrva. Pipe view Cmmebry
lendmaponsiwe ror Me remove Of wreonal Items from Ma WMeimer OrRoman Ole comment of Medereased. Pmeanal lmms deb In Me
Cards mer of flesh M , renal all the dommiced W the Omnebon Penews and cannel be mMoved after cremel
�T h li hareby suMMtt Pine View Caryl
1 m cmnw Me ramalm of the deceesad.
(OPTIONAL)
Sam member auM do the named funamI dInRW No preside car calvary to and caucuses by an alhmate
adMabry, If doomed mandum ry In Ma opmb M ln of fur l dlrMAi a nil m No MI b amend M N force Me contactcontactname and
dM at such almmax c me mory.
F NAL DISPOSITION
The(ereun authorized Or m "Me mmded mmaina Of Me dexaead from the acmeWryle:
Name: Camlmy Shell
Atmess lO Augmm Di Unh 10.Vemon, NJ 07483 phont. ]013lM10a1
The cremeRd mreine of de® Will c diepomd W as Mloaa
Hakased to Camona Shel
If be any mown ba Mean named aborodu9 net cake p.Yxmlon tithe mmi MnyM,
Pits ViwaCmmmtpy baugMMdbpiw{ munof
Ideal n*u
the g imb M.S. Kilmer FuMnl Hone bydeliwry
'm femur Or by rpi&wed mad. u..vromSrteean Gmu
Wlyna Pf INev. M20) w Page]d3
Authoriution for Cremation and Disposition
0:3111.. LLm.raxmWrg)
.�" l vow
buMBRMM NrtIIMBrBmeinsare not GBimB]xvMin lRO Erye MCRmaYcn.
Pine Uiew Cremabry
an shameless manner.wm.dgBmpenrig. aid.
tle meydlepwearnm anrwanm
CREWTION CO AINEWRN
rdeS�
rmgmeared /W be uxa m a�/w`h�os�eerbf aided rains has mean purchasa0 mom /' 1/ k;I&e trades c-iiiI �alu Me uma Ira email W MN Me entire a& ered remains anMdmmalr ¢ iwx WUWrortl&irery a nM yM FYrroning, Mb undarstand uw I no um le puMB or addressee provided
tory
AwsawwvB
roll plaretlre cremated remains In
a npH temparery¢nleircrbrhllrery
This AuM zadan Form area gowlad by Todd G tiyan` was euculedrt
114.13 Kidder Final Xnra mwmwrwx
136 Man 5meat Ad, Gene Fell, NY 13803 Idw.+re�ex�m
and Is signed b,the Nneral direm,as war em W im exeCBlgn
INJe haw re®lueg a Completed all of Sea AuMona mForm.
The pemoMe)Instilled Imme, Ii Me praoMa)In oanlol of estimation,wM10 sty signing this debasement Form,aMelt)
MMe how my and compNbnws of Mass Imomwilen mnYl In Ml Autlwrrzatdm Farm and auMohNa)ae twegoing.
Signed this and day M 'dy .Rg RO .
CemYne Shell � 1
10 Pldbual DI Unit IO,Vander, NJ%02
seem
rMnmw �
WITWU:
Todd G. 14Mer
�1r%8 rrv�/arpnmmw I/wv✓ vet net
uwsten emu
awesomeness
DOS-16 shf ilea. 0mrz0) Ppe 3 of 3
PIIIC View Canelery and Crematorium
21 Quaker Road
Queeusbury, NY 12904
Authorization to Separate Cremated Remains
Fnnerd Nn„w. --vz-_IS.Jnd'-- mm�-----PP_"_e
1/we xa larbx file senaeu4 o dW Cie wcd rcm./y�h�at
l ti/__—
I/we rurdwr q ec to Loki hanrrlesN. madclatlily :md deleod d¢ hercio named CIMI"Ido,lum aN w 11
ns tlmir rejaelewallvc5 It No M l ,ga;n.51 all claMs, huLdilics or d:naµ 5 wluuoercr w6kh nuy
msall from this aull - uon.
Crcmawp' Oltenlor___—_1 ----__
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