Simione Jr., Dominick J. Pine View Cemetery S Crematorium
Quaker Road
Queenshuryl NY 12804
(518) 745-4477 or (518) 745.4476
FUNERAL HOME: KR l N_ RETURN TIME:DATE R TIME REMAINS ARRIVED AT CREMATORY: 7IL u )')0(11L.
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS: -
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NAME: }�MVILlL sii iAV. sr' CASER
TYPE OF CONTAINER: rINEN GAS y�y,.
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ESTIMATED WEIGHT OF REMAINS S CONTAINE0. uG (bf Zi1O(Lf
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: 7111 YO
TIME STARTED: 7 Z0811 TIME COMPLETED: !0'4)],
PLACED IN RETORT: 1'3SAYI MOV90: plllftv� ,fm1
RETORT R IN WHICH REMAINS WERE CREMATED: 9WU AEtr Nth
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN a HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
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