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Benoit, Harry E. Pine View Cemetery & Crematorium Quaker Road Queensbury, NY 12804 (518) 745-4477 or (518) 745-4476 FUNERAL HOME: RETURN TIME: _ d DATE S TIME REMAINS ARRIVED AT CREMATORY: NAME OF FUNERAL DIRECTOR OR REGRISTEREO RESIDENT DELIVERING REMAINS: II 10�p MJIl -r pp NAME: DNA M•/ RuJln.\i- /A 1 1% CASE # 7e5 '�rY ,•,^� TYPE OF CONTAINER: f' rtiN.I Cn. i`Jef 8. 4 v Car'I. IJA /M U GPr PLACE OF DEATH: NMIrS IDwtA IZ A 5 y 1207E ESTIMATED WEIGHT OFF REMAINS S CONTAINER 1SO1LS PLACED IN HOLD: 100", PLACED IN REFRIGERATION: DATE OF CREMATION: 7-3-COL6 TIME STARTED: I Iit�- TIME COMPLETED: PLACED IN RETORT: IZ MOVED: I� RETORT # IN WHICH REMAINS WERE CREMATED: 5—�A DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 98 HOURS FROM TIME OF ACCEPTED DELIVERY: NOTE; THE CREMATION LOG SHALL HE RETAINED IN THE PERMANENT FILE OF THE CREMATORY, • oMSbL^ ///---+++ pepwlrneMal Steb goesK Uivisiun Of °"r' n,,,KN OF o p',g ST OF °I " °"'^ Cemeteries Alm .TY1223rapM Telephone.l3t(after ze aM9w Authorization for Cremation and Disposition This Aurh mf n Form mwtbe ample and algned prl rmtMivery of remains fes ce Qn. DM. 72ir2OM Number 1"V Cremamry Name: Pine View Crematory Quaker Read, OuaenaWry, NY 10801 51g-TOS66T/ nearew: vbre: CREMATION IS AN IRREVERSIBLE AND FINPL PROCESS. Cremation Is®coed out by paring Me remains M the d awd 00 theOppoes holding the remai ns into a cremation chembm"am tlwy ate augeded Ic immw hM end Peme. The boosted flame will imam rob one consume weryNing except bare and metal, wMCh are all thalwill be left~cmmation. Followingaemetim, the rrtmamry will take reasonable effai rental highs coa ins and Other material M1om Me oemetion chamber, but come minced dust and residue will likely the left behind. Tb v9ratnry wall w time inddmWll and breign materiel hom the remains and the intldental able foreign material will be disposed of assumed ed by two The cremated remains far b rrxbniwgy puNeMsd into small pieces and paced into a designated WMeimr Or unt. cremaltl nmvlm eemnllY are pulvetlmd uMl ru single amen N rxogniaMe AS SWMI Yww. OPEN XG OF THE CONTAINER The Panel may Only open the Wcener holding the unhampered human remains in limited Pwmstaneas,such sa to mnfinm the identity of the dewwed or to ensure that no mmenal is special which might injure employees or damage the aemalory Onnamb Y. If human remains ere delivemd In a container"job Is nM suitable fair currencies such u ceremonial or rental cuket,Ne crematory will nations Met Me remains ba movN into a suitable co it before It accepts Me remains. The opening lea container or the transfer o renval of retina yet be mMd bef a whal and will be done In pmacy,wM dignity and respond DENT F CAT ON OF E0 fm md—d Name doema.aa: Harry E.E. Benoit McMI smue Last Known nddreu: Harrisburg Road, Stony Creek NV 12878 residence Place Of ea 97 af//1922 ]/?J2020 Ses: © tA OF Pge: DOB: OM of Death: betted more � N=ppm aaske4M Miner 0 ubich remains we by Mesabi McDonald Container Basic cardboard cremation container; no interior CONTRINL OF DISPOSITION asstom)N Palmed crap rion, typal ONE NMe"'i I.mMIs Are the designated agent aMe ltteaead unhorsed In a vnp or wrmm uddrumem eaewNd pursuantm Public (,Home laSectionSeon Q01. k �O — INJe mare M knowedge Mel the dewewd neateb a written instrument pursuant to Public Ha9M Law 3mbn 4201 OF yell mtlnal dkmtims fa lb Malcolm a his or tar remains and I/we are t pemm(s)having priority under Public HwIM Law sention 4201 and bye the right Summers Promotion of Me remains of Me dxeasw. All relationship mMe deceased is M fdloww Harry E. Benoit Pagel a 006.1gSa!(Rn. Oeltv7 Authorization for Cremation and Disposition Ma rdnw:re! 4 w,enicary nun hu rem e a mi nu are a.imaewinm fzoaeyaaaemeua,, Piro Mae Crmrela may avpaee of Me nme'ma in Ass,aoiismi an irretrievable manner,such as IS wnesell CREMATION COMA NERNRN r�I ONE OIMe Mowing) An um M m Anne as a container for Me overseas romans has MYI POR B aE hen aria is E¢N.nhee w relays Mine understand flat iftt a um is fw most to add Mar en&e cannot nrmans an additional real conWner now be made air e&i M um is non yel pordemed. Noe uneealend that I m um b PaMasad or Mhemee provaee im New Crematory MII period Me crammed remaim in (adas"i a red remrorary container or delivay. Patricia Miller was remainder a This Autlwrisslan Form wu resided by nevamxaa Brewer Funeral Home, IM. za Closer eL lake I-aeme, NY ISMS T� Now ,.wa»>,.Ashen ant is srenN 4 Me funeral dirot as wiMeea to hs execution, W/e he"reroived a compared wPy of Nla AAMwleabos Fear TM pencerm) leaders belox Name Me"Moore) in caMd of dM{uleoMwro by argon this AuMwiatlan Form,a1W45l tO Me accunry and compiseses M Me Information conWrotl In MIS AUMom = Pam and sudwrlWel W fOMOing. SignedMia 2 my of-.Jury 30 Z1��// "7'3M M *k n ant �i F/ 3 -97716 Iasi PeMde Milew aco-Drdsnwurwio u1�+S 12145 Harry E. Benoit nO&Ie f(itWIMIe) Paiii Authorization for Cremation and Disposition ((romrt for;the xx Wow) 3 son Number_ Desrmnan 1. A person designated in among pursuamm Pubic Heats Laxation 4201(3): 2. Ter washing spouse; am. The wMnn9 mmewe partner, S. Any summer mild sail wars of age or older: A A surviving Parent, S. Asuming sibling eigMxn years of ape or older; eared guandam T. Any Maiiwn(s�eighteen was of age or older eoal¢E to Share In the Slate and who Were closed in relAmabip W Me edCYdM', S. A duly a document fiduciary of Me estate; 9. A dow mind w skave were hasereuned a vmMn statement pursuant to Pudic Health Law Sal 4201(7), 10, Achief fiscal crown of a Wunry,or a public aaministrMw spOuntM Wsuwt to Me Surrenders Court Procedure AL; 10e. Any cnrperson wtw is beDng on behalf of the Sewed and Mo has masted a w ithn statement pusuad te Pubic Health tewsedian@o1pl. * (�ynu TNwEE a Me muoairel pa� Mile hereby base Mat Me b]y of the Moment does not Wnum a heavy, baftery pea, power wo, annual in deed. or madioweve decom and"any such normal vrte removed prior to Ne amount of this Astronautics Farm. Fallusb mnova Mail Items paarto canal mry mull in hands title cnmdory elf oremsWry Wreannel. IAYe arum that lnsWctions haw been given to Pull NOW w mar regarding the removal deny rersond property or other thing of value wTiU any person signing below or any family Member of the Plea Show Cremdwy deceased acres to presenre, he net reaWnsiae far Me removal of Personal items horn Me moment w Rom Me rlemains of the discussed Personal hems left in the conchae or wxh Me remains will W anetroyad by Now aremdlon pr S and conmt W narrlwed after aremsal Pine New Grammars NYe hereby subindex rce..w.v++w ts aemaM the mneine of Me dec W. FINAL DISPOSITmN The person euawri:M to rewiro tlta vemamd remains of Me aewued ham the Necessary a Snorer Funeral Hone, Inc. Nam 24(Murch St, LVMe Luzeme, NY 12M 518 2740 Address: Firmer The aematM answers of dewaina Peru W damwwd of we Fallon: burial in Glassbrook Cemetery,m Stony Creek If far any reason the person namN above Wee not rake Pcuene0n of the aemead reaches Pine Vheu Calends y aeumMlzeO to pM indictment d the renm%to &ewe Fuaral Home, MC M,MNM• in Mason ar 4 registered mall. Pmwrvxe Harry E. Benoit DOS-lsn&f(Rw OPl15) Pagazda