Edwards, Marjorie E. Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: ANLANAEQ _ _ RETURN TIME: ___
DATE 6 TIME REMAINS ARRIVED AT CREMATORY: 7ILIy IDAPN
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
0AW AURtaaoEo
NAME: __ _ fN WuRntr —CASE '29
TYPE OF CONTAINER: N 45 IIN4 drint 4q,IN—
�
EA PLACEOFDTH: Ili 56 Bowl ¢ Lin L 1 WiL k A 17ds3
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER 9T6 IM /IWUr
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: �I/SIV q
TIME STARTED: "?;OO M TIME COMPLETED: 1'JEPItI p
PLACED IN RETORT: I %Atl MOVED: S-YCAM I n
n 1fkRETORT El IN Fr IN WHICH REMAINS WERE CREMATED: bywFj( Hy
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN OS HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE:THE CREMATION LOO SMALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
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Authorization for Cremation and Disposition
TIIN ArMorze m Farm must be completed and signed prior b Millmry,or remains for cmmwj
Dee. 07MIQ020 Numbs'. 'I86
Gremstory Name,. Pine Yew Crematory �
Address: 21 Quaker Rd., Gueenabury NY 1280d Anode: 1f18� TY6-44
CREMATION Ie AN IRRE MIBLE AND FINAL PROCESS.
Crematgn is eanied oN by placing the remains of the dere and Me Panel holding the remains into a cremation Term racer.
theyartsubjMedboinuinseheatand (lame. TM Matt and flame win Incin W and cornume WIMMng exceo Band media
which ere all May WII by May prier champion.
Following champion.Me crematory will take reasonable a ores to remove all of Me remains and other nickel from the oemffion
chamber, butscne metal dust and residue will likely be an blind The crematory will eaparem expanded and foreign insured from
Me rem9es and the im dexul and foreign material will ce disposed of u so mrea by law. The"mated remema will be monastically
pmvenmdintox lisettsaWplac innaaemgnat mneinerwum. Cre SM remalmgenareflyampulvMpeduMlno
single fragment is mnntr Was skeeel have
OPENING OF THE CONTR NER
The Normal may only open Me wnWmer holing Ma urvGemeted human Normal limited circumstances, such as b sent"Me
Near starts a
e recorded or to ensure that no maerialm crossed which might injure emorki or damage the century pmpedy. If
human remains aredellrersed In a consumer which sk Nor suitable for crummon such as ceremonial or rental send,Me
criminal will sepume May Me examine be moved Into a ameba barrel before It accepts the remains. The opening ma
container orthe Iraruferorremorel of remains will be conducted before a witness and will be done In privary,with dignity and respect.
IOENTFICATION OF DECEASE°
Name of Deceaad MarjoreE Edwards MamN Status: Widowed
Last Nnewn Amrem: 835 Blooming Grove Turnpike, Apt. 21, New Windsor, NY 1250
Piece a owner. Eldervrocid at North Creek, 112 Sd Bowl Rd., North Creek, NY 12853
See: OM ® F age: 92 toe: 05116I1928 Di m team: (Sill Estimated weight 85
Metal of wakeVmmMner in which remains all be ma i"Ned.
New England Cremation deluxe container
P�N IN CONTROL OF O SPOSMQN
fvrmnts)maarw mdmpoalnon, e�oNE mmarodw+nal
I enjoys are the designated agent of Me deamed designated in a wnl or when mmmmerd opposed pursuant to Public
Neam Law secrvan 4201.
-0R-/i
3 'S Me have ao knowledge me the dexaxd seasoned a written lmwment pursuant to Pultlm Mouth Law Sttnan 4201 era
nID command direcnona for the symbo pn of his or her remains and love are The pemnR)having pnorny under Public Hal Lew
Section 4201 and have Me rrehtts compiler champion MMe remains of M:¢aad. WMurreil shipeffiea "$SdYm
rot s
Marjorie E. Edwertls
005-189NfrNv
Wrznl Page 103
Authorization for Cremation and Disposition
(Insert M1om ma add aN )
Namber:3 DWitimsen SUIVIVIgho Child
1. Apsrwn MagnetM In wriang pwsuanito Public Health Lax Sesfion<2011a1;
2. The sumv'ry spouse;
L. The eurvNlrg domestic paMer',
3. My remain clots eighteen make Of age or drier;
<. AsuMvirg parent)
S. A inrovirg 9bling eighteen years of We w older,
S. Ala lly appointd guardian;
2. Any person(s)eighteen years of"a 0r mkkr Mtitkd to share In me atlab and who Were closest In reletirohl tithe decreasedl
8. A duty appoints muciery of the mate.
9, Ado"bond or server who has executed a written statement pusuant to Pudic Heats taw Section 4201(2)I
10. A Mief fisol ofimr of a county Or a pee Administrator appointed Wmuaot to the Sun take 5 Court h ure All.
for, AM other person who is acting on behalf of Me deceased and who has executed a widen statement pursuant W Public Heats
law Section 4201.
(ndiL ALL MREE a fee fdbu4pf
Me hereby An ran that the body of Me deceased days nor domain a battery, battery pack, power reR rafiwdirt Implant
or radioatlive device and that any soU maenals were rermer prior tot"execution of her AYMotlaaN Fenn. FMiunbnmo
Mi(/�/ip��me pro tocm ion may result in ham Oren me cr "and cn m mary graonrnl.
4LL INie affirm that inservedomm have been given to David Alexantler
regarding the removal M any Nmmi property or Other ming Of value which any parson staining below Or my family member Of the
dewabd wiShesto preserve. li V' C mato
is netmeponyble harthe removal a mre0nal lays from me container orhom tM wins
ache daraased. Pa Wnel ltemB IA in me
onmmxor Mm the mmaiM will ba dn4oyed Maki aremnlon pro eau and cannot be retrieved scut manager
M hereby authorize P'namVi Crematory
nvor
Or Cnmah Its remains of the 4ac8u .
India)OPncrack)
Uses hereby authorize,Me named funeral director to provide for delivery by and mma0on by an alnmate
remb ory,0 deemed necessary In the opinion of Me funeral have or,and to amend be;form to pmvids the correct Dame and
add MSS of such alb ate cnmi
FINAL DISPOSRIOX
The pmon anamonvered to hadown the coved remains of the dece9aed from Me cnmelory is
Name:Alexander-Baker Funeral Home, David Alexander
Address: 3809 Main Street Warrensburg NY 12885 Phone: (518)623-2055
The camelN remaim Of tlett N will be expand Or as older
Return to family
HW any murder 1M pension named above deas not take possmion Of Me uemeted remains.
Form View Crematory is aumc to airs p0ueeeionof
the mrmimro Alexantler-Baker Funeral Home bydeiinry
n..xa.,..aw
in person Or by registered mNl. Madorie E. Eckab
1ra.ro.m..a
DOS-1896f(Row.Oeao) Page 2 Of
Authorization for Cremation and Disposition
r�ma avWwmy
—Sf—�Mwa andersteM that a the remains are me aaimea within 120 arye M cremation.
Pine Vies Cremetary may discuss orMe remains in
w.ndu.v,.n
an irnaMevable manner, such as by ewtred.g.
9REMAT0NC0NTMNENORN
(ki IONE ORhekNowli
Alexander-Baker Funeral
An urn to Ce unit as a container for Me cremated mmaina has been purchased from u.....e
ends described aefaloww MCCKen i ie umNault-Rose
me understans Mrs 0Me um is too small to hold the erAre ca mium margin an addlhon at and turns ner may be unit for dismiss,
OR-
An urn laMyetPurolator, VWa understand dbt if no um is wmhrrad or othumaye provided
Pine View Crematory will place Ma cremated mmairm in
nM+
a nod ancestor number for farmers uw�mn
The Auanom.dan Form was prcvlded by David Alexander was exeamad at
Alexander-Baker Funeral Hone
3809 Main Street, WeWiertsburg, NY 12885
rA a signed"a wnerel all rcclar an artery to an execution��u
IAve have rewired a competed aqy of this AU oWa nForm.
The perms]) Idea Mad Me"]Were Me"counts) In control of deposition,who by signing this AVMMaaN Form, aNeatlet
to Me accuracy and complements of the Nfanmetion chained In this Air odaatbn Form and autl rime)M ftwoing.
signedmis 1at ddi Jury ,2a 2
Steven A. EAvards
39M Main St., Wanearml g, NY 128M
wi
vnTNEss:
David Alexander
W10034
Marjorie E. Edwads
1 0 1We"(Rw. 0ar20) Pagel