Hurley, Geraldine G. Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: _ RETURN TIME:
DATE A TIME REMAINS ARRIVED AT CREMATORY: -I AIA �Q WIIT
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
NAME: suywI4ts yaoil CASE aM
TYPE OF CONTAINER: U W . a /r.t
PLACE OF DEATH: 84BpPt, �F hcnta l�N
ESTIMATED WEIGHT OF REMAINS A CONTAINER
PLACED IN HOLD: A�
PLACED IN REFRIGERATION; I443b /III
DATE OF CREMATION: -IIIFI m
TIME STARTED: (On—TIME COMPLETED:
PLACED IN RETORT: II'Ifllu I MOVED: 164m1n'I. . ZO n
RETORT # IN WHICH REMAINS WERE CREMATED: MIR- ?MkAK
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG BHiu BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
z New York State
OapalMeM crashe
NEWYORK Division Of ONISION OFC METERIU
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OPPC TOM,TYOne Cammerte Plaza
CemeteriesAfter.NY 12231-COW
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Authorization for Cremation and Disposition
They AMftdmrlon Forks must be completed and signed pH todmlverr or remain:rwerenrauon.
new, 07MB12020 Number 01,
Crematory Nene: Pine YMw Crematory
Address: 21 Cualler Rd., Oueensbury, NY 12604 Phone Nl }16'M()
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremations canned Out by PWN the remailm of trip demesed and me comemer holding the remains into a c "ontl8 MTere
Ivey are sugemed to Intense heat and Pe" TM Mat eM flame will lndme and consume ewMMng except bone and mMl,
wlrlowng daemon 11ecar allay take
re.
Following Wsomon the vl dust and residue
reeaonabkellech to remove cmme remains eMsei me l and
mtheuemerial
Member, sacame minimaldwtd foresiduawilllikely we nth banded. TMaerrmy by will separate Io malend(:reignma onlham
the remains
into nd
al and dl inmaMnalwillcaeNia of as regmred raw. TM cemetetlampulvece until may
patveerea mo small place:and a AS s cum.deaigneled wmeiwrpr um. eremat.e rem.w federally are pmaedud until w
single M1pmeM b nwgnluble u eheNbl tluue.
OPENING OFTHE CONTAINER
The Optima y may Only open the cancer ml the umcreal human more in Iimitan drwmental such as to Lalmrm the
ident of me deceased orm ensure that Ica mMnal is encmmul whits might arms amount car damageme Optical prupperty. 9
human remains are delivered In a eomelnerw ich Is nor ammble tneemmeaon such as wig vial or rental wabb me
cmaWrywNI regwremn me renameMmevM Inroasuitable wmamer bdoreaaaeph me nnulna. Thecharm ors
ontainer or the number or minoval of remains will be normal Mlore a wimees and Atli Ire Me in prlvwy, wM dignity and respea.
IDENTIFICATION OF DECEASED
Name of Canonical: Gereliina G. Hurley mawi swue. Divorced
Ian Known Addrees: 1330 County Route 24 Granville NY 12832
Piece omeatb. Albany Medical Center, New Scotland Ave., Albany, NY 17M
Sal. OM IN age: 64 We 12/31/1955 Dam of Damn: 07/0212020 Esemmedwddd 150
Deeatmlw or wmeumntal Ilex in wn'ton remans win ce tleivered.
New England Cremation deluxe container
PERSON IN CONTROL OF DISPOSITION
(Porson(s)M roNMMda(nsiliwr. initial ONEn`me Mbabpl
I amNie ere the dmgnaled agent of live measured tlHigmled In a MII or hMbn inebumem executed pureuenlb Pubic
HnM Lew sedlm 4201.
DOl
IAll Nve no knpWl¢dge that me Mitterrand executed a ware n instrument pursuant to Public Honda Law Shape 4201 or a
win con diving direchat for the cimpomiw of his or her remains and Mae are Me panel having Audi under FuWM HMM law
Section 4201 and have the red to assured cremaon of the Mahn$Of me Ceceased. Myli mint hip to Me daCNsed 4 as
follows:
Geraldine G. Hurley
OOS18gbf guy Gui Page 1 of
Authorization for Cremation and Disposition
nnaad6amme 4SfMWw)
Number 3 mscnpuon SUNIVIM Chid
1. Aperson desgnateO in random pureuaMW Pulse HealM lrn Seciun4201(3);
2. The working spouse;
2a. TM smoking describe pander'.
2. Any mNNing child eighteen years of age or older
<. A hmiming parent'.
5. A surviving sibling; madman year;of age or older
6. A lawfully appointed guardian;
T. Any proun )cimmonyear¢ of her or older alli0od to sham In the estate cod who same cbeatl in Mann¢hip W Me deceased;
S. A duly apointed fiducary of Me made;
B. Aclose friend or relative who has rebuffed a written statement pursuant W Public Health Law Indian 201(7);
19. Adead fiscal Parker of a paper a a pidic administrator appointed pursuant to the 5umogateb Court Promdum Act
10a. Any other pemm who is acting On behalf of the deceased and who ham mounted a women statement pursuant to Public Health
Los section 4201py
L(inkou ALL T Fri drive/Nbwing)
INYe hereby aRom that the body of the removed does not pamain a bM", battery peck, power Wu, marked" Implant.
or radioactive deem and that any such motena6 wxe ramered poorly the eaecul of Mls Autlmlizmion Form. Fd1Udatomrove
Mw item¢ prior W cmmetlon very neull in M1arm W 6re cnmMryantl cmnvbry pmanrml.
Idle argon that immnictau have been glvenW DB�yitld AAf ander
regarding the removal of any personal pmpnly or agree Ming Avalue which any person ugnirm bemw or arty HMIy mememr W Nb
demandetl wishes to preserve. Pine View Crematory
is net reapanaible bode removal of barrels items M1am the conformer form the remains ofhe tlemnM. Pemyml NamslAin Na
comment or with the "at"will be destroyed by the cramatlon pla.We and cannot be removed after cremation.
Ii h"re aWM1arize Pat VFW Crematory
n wx.7n to cmmate Me"mains of the tlK$e .
(ParisOPTYWL)
may hereby amM1oriss Me named funeral director pmviU for delivery to and cremation by an al"mata
"oratory,dtlwmad necessary In Me opinion ofthe formal director, and to amend this form to provide the correct Hama and
addms of Such alternate c"mabry.
MML OISP SMON
Theperso Mcdmd to reel the uamatm movina W Me d acted from Me crematorym
Nam'.Alexander-Baker Funeral Home, David Alexander
Alkill 3W9 Main StreetStreet Warren6lw�NY 12W512W5 Phone: (518) 623-2085
TM vemaW remium of dismissed will be dbpoand Of ea louyann
Ralturn fo lannity
If for my mason the parson named above does not take possession of the uemted nemeim,
Pine View Crematory IS amharized to give pasaessonof
Me remains W a Alexander-Baker Funeral Home M dearary,
in lraean or by reglstrred sew. p..w�r.mu Geradine G. Huller
Dos-160e (Rev. Oni mm
i Page 2 0 3
Authorization for Cremation and Disposition
(flitmisofwl ma forward)
V 1l Was understand Mal it Me remains am M dammed whin 120 days of
1f Pine Vrew Crematory may diapersd of means In
Oftow"wes"O
anim tMrin Mei manner, such as by wa9.
CREMATION COWAINEWURN
(n I ONE of the fdrMng)
e An ummbe uamnamnMirernrMe memarce remains na been pumMaed from ule%anger-Baker Funeral
ands nose as folicwrs. MacKerude Urn/Vault-Emerald
ii understand had if term ar too small hold tell wa ra[remind nmera, an additional rigid dish finer may her used for delivery.
OR-
AnumisrotyetWrchased. MeuNm nd MMd Wumispurcdas crolnemw PmAdsd
Pine View Crematory will page Me crammed remains in
nvvw "rewe
e rigid temporary container for delverr
This Auuwnzmon Tom was predicted by David Alexander was amounted at
Alexander-Baker Funeral Home
3809 Main Street, Warrensburg, NY 128M
^ r a 're signed ov Ma Nrerai budget as emerge toits executionon nd
Ii have readved a compared copy N Mk AutlwrizoWn Farm.
The pemmusi IdM ed below Were the pananlal In control of disposal who by signing Mh ANhorIDtlen Form annual
to the accuracy and complNmees 0 the Informal combined In Mis Authorization Form and sufferable)the foregoing.
Signed thus 8th day bil July 90 2
a
Erica L Hurley jr? Lp a A KL.yy
1330 County ROWe 24 Granville NY 1283E !1
were
a.....a... saw•
warm
Davitl Alexander
6vspwas rMrmvraer
1003d
Geraldine G. Hurley
p..eo...w
005-18984IRev. Onli Pail