Sargent, Mary C. Pine View Cemetery S Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: _ ZDS RETURN TIME: pI.
DATE B TIME REMAINS ARRIVED AT CREMATORY: 6Lvj aD I 'L(Ofh
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
M hmii vc'5rMbtt
NAME; IN60 ,S�AIer£/9r CASES 786
TYPE OF CONTAINER: DBMI �C (/IY lW� - 414W I4 I,'(YJky-�
PLACE OF DEATH: ;E� 54rat 1 CF 914 'M 11$O(,
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER iOD µF
PLACED IN HOLD;
PLACED IN REFRIGERATION: z;OO pY)
DATE OF CREMATION: �?A Ito
TIME STARTED: TletH TIME COMPLETED: 9'SBYAP) �]:.
PLACED IN RETORT: 1;)SAIL MOVED: S'iD AN . Q6mn qat
RETORT O IN WHICH REMAINS WERE CREMATED: $whQ ltl1[lL
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE, THE CREMATION LOG SMALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY,
NEWYORK wp.nm..e�eea.�.
nATroF Division of DIVISION OF CEMETERIE5
° °°" Cemeteries One Co.we,
TravenolA„m474A2 s'
Authorization for Cremation and Disposition
ThYAu"w/4a Form must Ww plN and sI8^ea pHbrto assembly of remalM for dmVmddn.
LOW 0 812020 Numbs -)To
cremakry No" Pine Yew Crematory
address:Quaker Road Queenaburv, NY 121Xt Phi (518) 745i470
CB TION IS AN IRREVERSIBLE AND MM PROCESS.
Cremation is demand old by plvunB Me remains 0 Se deceased and Me combirer holding Me rmuan am a min mWeberwllere
May are mankind to intense Ygat and flame. The MR and Nmm Will Mclneab and c um aw "assumed pine and meY1,
ad icb am all that Will be Nfl spar crmetlan.
Falfiv rg customer,Me mmatory=it take mawnade Will M moreover 811 Of Me Rm u eins and sit ma lfrom the membrane
clamber. but some minimal aunt and residue moll I&eN be Inn dddNO at mmalwy unit separate inmdeM l and image matahal for
the remains and Me Imadental and enough mmdel Mn be diapoamd of n ensure My Inw. me command remaMa all be metllaniuly
NNSd dinbmmalgeremaMpla d ,l admgnaM =nlv son um erenWWd immnemilyempulve Munnlm
singlahpmal is Amber eable as skela l tinkle
.
OPENING OF THE CONTAINER
Thet ham may only open the container holding Me unCnmaled human remains in limped &mmmrlcee, moan as to Wmfim the
human a Mededeased orm en Ina ontenerw ich enM$W MlOfOrC io eamhaeaa nial Memme skexro H
human mall Ina InaIMln Mr iknasuhabialon Potationsuchcueammwnlalors. nmvn, the
nmvtor orM tmuln Mat the nmaim eamouth icon a conducted
bf conmNx before 1vecapb tln mac..w The ply and of e
anmmer antes tmmfor or remove aremama wiu x mnaamkd alma witmo ma wall waona in pnwacy.wan dankly and re.md.
OENTIFICATON OF DECEASED
Name of Decanted: Mary C. Sarpem Maiden Stalls: WPdowed
Lau Known Addrdi 170 Warren 51reet Glens Falls, NY 12MI
Plain of Dun,The Rrrea At Glens Falls, 170 Women Shred, Glens Falls, , NY 12MI
Sex: ON ® F Age: 99 DOB: 04/0611921 OSMcfOw 08127=M EEMmM m'. 100lbs
weOIFA9n a CaskNl Wmrk which rmlmm will be dellmmd.
Buffalo Casket Company—Alt mntainer
PERSON IN COMM OF OMPOSIII°N
*�(eemw,(e m mrmaamepmkm'a,. ;moral oNE nrlrrk raawrry
I anti am Me designated start ofMe decimal designated M a MI or urban Instrument annual Dumont M PWic
Health Lax Seddon mini.
OR.
IM/a Or no klrowledae Mat the aem executed a written instrument pursuant to Public Heats Isw Section 4201 Ora
will containing dimrliom for Me momentum a his or her remains and awe are the peamis)hawing pnodry under Pubod Heath Law
Swarm 4201 and ham the night audarite mmatlal time remains of the Seoul *MurniW rsnip MtMbcaysgMm
follaws
Mary C Sargent
DOS-18984(Rev. 0010) Paget ol3
Authorization for Cremation and Disposition
llreenM1w Oe na mrow)
Number: 3 Description:ChildlAaent
1. A Posed deslgnatM in wvitirg Wmuanl to Pudk Needs Law Betion 0201131: -
2. Te surviving Minute,
L. TM1e turviving domed parmeri
8. My surviving child emblem"am 0 age or dtlen
L Asi lMng parent
6. A surviving&b4mg cthamin yam of and or door
S. A Invest appeiMel gueNW:
1. Any personlsl epbasi years of pe or deer breeds to snare in tMestate aM he tram boMal nlNMal to the baseball
8. A duty Mounting gamary b Me all
9. Adoes Metro a rights"who has exeWed a written statement pursuant be Public Had Law Semon Q01 91:
10. A UINMnd officer of a county or a public administrator appointed persuade to the Sartyate'a COm Prombi Act
10s. My deer person who is sting or MNM of the deneaetl add who has executed a wblen stztemene pursuant to Pi Parent
Law Muston 4201(7).
(�idal ALL THREE orfM a gl foson
>:e 0 INie Inertq aFmm that Me body of the eeceaum Wee net contain a batten, tvMn pack,power evil, tenlotaive i entim,
IXM1WO dewmaMthManysuhM1m naW"mramo pnortoeesecutnnoNlps AUMMv Form. FaflumWmeve
Ma!deIb(�ms prior M cremallon mess reauN In M1am M the Random,anal crenueery pnmml.
14 One am=lIm musNpMa have Men given to Mered JDeSimona g .D
asw
regarding Me rengval dany personal pessary or dltw thing of veM which any person signing taken many f smiy merger or Cs
sediments wishes l reveal Pine View Crematory
"'w" m
is not no ponsibe Iw the remm'al of model gbms Ism Me Wnldiner or"in Me remains athe daamen. Personal rim Mh In An
consider or Me nmslm war An destroyed by Me cremation prows and corms m raNavae after Reveal
L ( Nye M1enby sutM1erte Pine Maw Crematory
InCm a reed of the dxxdm.
(In�OPTIONAL)
Ywa hereby auMonee the named IYmral aryQp to provldd for delivery m and weal by an al lmaa
rsinett fieemetl barel in the opinion of Me runersl director,add to amend this form to reanimated do too nenro aM
emend of such vernal crematory.
FINAL USMSFION
Te paem until to renrva the aerated remain d the M M1ln the oaetwy lc
Name.Thomas E Sargent
Adorable: PO Box 83, Cleyerdale, NY 1282U Pnora (528)858-9998
Te Randall dismiss of daeaed wN be demnd of a address
.
Retum cremalns W ft family
N V any Mason the parer min Amend Mx not use mawdeka oftlw vemaldremaye.
Pine View Crematory l dWwnds l qual Reveal of
ro n
Me rsm m to Ragan Deal Shall Funeral Home by delivery
in pammaby digllrsa ma. Mary C. Serpent Awswuss'l
UM-18984(Rev. MROI Pape2a0
Authorization for Cremation and Disposition
' rMe dMhavMal
` R 'Y IrNe uMmltM thin Btle remands art net Wimed within 120 days of cremation.
Pine YewC atary
end may ai.Pmaddthe WmNna In
an Idreuwawe manner, such as by scardent
9RE1RTION CONTANEMRM
ought ONE at me rowwni
Regan Denny StaNerd Funeral
M um tO be sad as a Cemader for Me,oemadid remains lug been numbased M1om
and b deewded as bliss
Ii undenland Met it be sun is WO small to hold tle mbet wnebd remands, m all meld container my M made Rr dtllwry.
oR-
- ✓ii .s. nn man lddw rat weeded. vwe m�aendwatnam man la Pwmeead wduwwiae Pmeam
Pine Vim Cramal dip pace the xemadd remains In
a dow mddrvary antalrerry delii ecv�
m$auNd aum Eomdwmpwpw by Mark J. DaSimone was exerured at
Ragan Denny Stafford Funeral Home
53 Quaker Road, Oueensbury, NV 12804
and is signed by the antral d rdsoor asw den m he command
INJe here de[alved a wmgetm cony of this AmM ag Fwm.
no Mean ldenuned deal Islam Me person(s)in epNol of mislays .wM bysigning made AuddodaeMon form,ee4sgsl
W MO accurately aM canpleanass or the iMomuticn commands M this AUMwft~Farm and subnormal ae baseball
stenad Mla 28N days( June m 2
Thomas E Sargent t f
w
PO Box 83, CleveMale, NV 12820-
M.adaMerm. w
WRNE88:
Mark J. DaSimone
n�dda..-m..smr.ex�e dn.
10919
Mary C. Sagent
Weals
COS-0898dlRev.nano) Pge3al]