Ward, Jean A Pine View Cemetery & Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (518) 745.4476
FUNERAL HOME: __ �t1D _ _ _ RETURN TIME: OOLLD�
DATE & TIME REMAINS ARRIVED AT CREMATORY: 711D) Z0
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
- POD LtA6(6
NAME: _ WAR ^ CASE It Q(O
TYPE OF CONTAINER: mlxr-
PLACE OF DEATH: zn add p l A IiH M
ESTIMATED WEIGHT OF REMAINS S CONTAINER (6,0 /h
PLACED IN HOLD:
PLACED IN REFRIGERATION: __ L.46f�
DATE OF CREMATION: 7-/LZiEU
TIME STARTED. C 4a— _TIME CGIS^PLLE�ETED:
PLACED IN RETORT: 24� MOVED: Dy ' 2t�
RETORT A IN WHICH REMAINS WERE CREMATED: '5gec 0,�r:
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN`4E HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL BE RETAINED IN THE PERMANENT T FILE OF THE CREMATORY.
ak Fbe
Determinant:n
TEWVORK �IVISIOfI Of DrvIMOayN�OC.,mal pie.
sal OF
DFFDN in Cemeteries m^
Y V231,00M
names" SIMANa.aa
Authorization for Cremation and Disposition
This ANhonaation Form must be complT d and signed morro delivery of ramalns for cremation.
Date: July 9, 203o Number.
camormby Nema. PPre mIXenabmm
AMren: 21 Emery Read p1¢¢rg NY Units M. may. (WIN 74SMrr
CREMATION ISAH IRREV MIBLE AND FINAL PROLES
Maares Ia onest artoye heard ate Rest
tand fi v wale WnmW WYIDnerim,nIribnvem&Im UbmM else
May are subjectedafeGed to IMenea heard and flame. The Maland flamaslll ImJnenbvM oannumeanrytlllrlB ea[Bp10WYMd meW.
Folio en all ati MIIEa left ataebr nemetlon.
Follow tic but some
the al dusts and
al reasonely elbdetoi remove aIIWtie "li and O in mebnelhamtermm�
chicarter. SN adm inai&a lalend WmMo will
nalmyE disleft m^d. red uifWW vdll sThere ntieenrelene lcacgnma nM1MI
ae remainsand tte Ivesel alandlwegno alenalnaild canoneetas regulred In Ise. Thegre l mpuwIMCemurimalry
pulvenreadmic fragment
t Is aaWa and ease!into a dwlgntled wrminerw un. cremkbd IamalM eanxvlryaro pulvxbeE uMl m
stasis Mgmem Is rewgnisele.e.knatat mm.
MNIINO OF IHE CONTAINER
The chromakery may y oPo^the contaerer holding the uncranata]human remain In limited uwm5len¢e. soon as to confirm Me
human delivered
I, a Nmunerwicho; not su Much migMiaonsch aesaCamage ornicaryprophe M
camera bmab.na Met are
naconhbe.whlmis ^otaut W rorcmne0on SUGaewremMblorienbl Waning
eremebry rain rpninaatate nmf re Oe mesa Into a euroMe wawaye s and nacwpbae remains. h di cperend re a
container transfer or,easel of remains woI be endeared bebre a Mmeas and will be none in pnva¢y,wgM1 dignity end respect_
IDENTIFICATION OF DECEASED
Name or Deatal Jean A. Ward Mental Sawa: Marled
tLast Known Address: 2000 play. Core. NY 12023
Piece of RM: 200 Daaet Dire. CorMi, NY 12822
Now 0M EF Age. 73 WIL 0511611947 DMOD a: 0270Sa2o20 EOmeme WegM ISv Icy
OmwpNn MCaskaVtMwiner in ettiM Rmeim AN he ddiuvee.
(rypelmatenaYmwellmenuwqurer) MaNesa Advocate WcvM uq Cme[mN Cmm C W
PERSON IN LOMIROL OF MP MM
d nave(comyrd di9w8dwn, Mines ME a Me mkxmgl
arki ere Me desgialN agent ofthe a oW e4igrmad In a will in m Instrument meCN¢d puwam to Public
NMM tans 3e son<2o1.
-0 1
W e have no knuMWga ME NedM9aeel exeuMN a woman lnarNmors pursuant to Paulic Henry Law Section 201 or
all wn rining Meant for Me dnpAiOw a1 h15 or for remains and Ilse are me Al having platy under Pudic Hm" lanes
S on4Ml and Mud Me Mrsto aWAaixe a Don name,remains olae deceased. WMurmladonshipbaedeceasedbr
blbsa'
Joan A Ward
O &l1 f(Rev. =15) Page 1 of
Authorization for Cremation and Disposition
pndartnmmmausebatw)
Nwnlwr 2 oeampticn: surviving Husband
1. A person nonisentia In wilting pursuant tO PubYe H l8x5 l41
I. The surviving spouse:
b. Than survives domestic partner
a MY surviong cmd rsmeen years Of age or seer
a. Asurvwmg parent.
5. A eurvwmg sibling eighteen years or age or older,
5. A laMuuY appeared guardian:
T. Any post nghhen years of age or older enchadmshare in Name and who share clmeetm relahomhlp to Me daeased:
e. A duly accused nowlary of the estate
S. A close hleM or relative who has executed a written statement pur l m Pubic Halm taw Section @01(T):
10. ACMef fiend Omrer of a wants da a pudsatlmmanaer apponed Pursuant b Me Sunogeta'A Coon Proxlure Asa
1W. Arts omet pGaGl who is al On pehalf M He EX4aeE and Mp has Real a warden amtemeM Pursuant to Public Heats
Law Set 0301(i),
rat ALL THREE YMe NW")
?of A Asy hp'BEy affirm that Me bWy of Me dtteasM does not contain a Wagner. PaWry peck. power tell, unusual secure
or restorative OadIX and pal My such contends NCre removN paw to the announce M has AuaMHZa ft Form. Failure In real
♦ tl�l(wa Aden parer m cmaem may fault In ham W Me cnmae e ry and cmeterym paonnal.
.r J.W . NVe green that instates have Mean green Rc 1. Danambre m�
Regarded Me removal of any Memel formal mal or Other tong of years,which any Person eigninq Way or any ham member Of My,
dxeawd sWtea m and" Plranex Cremetaium
u not responsible for the ranwel Of personal dams Rom me boost a hour the remand M me decassd. Po m$Wes Ml Intlta
yco' MLfner Or MN Me samaMg veld b Manuel Me crenetlon pr and Gmmbe rebkva0 aha meal
. y=lWa harepY auMorm final Cremamnum o�ry
tocm ow the mnalm of Me MugW.
FINLL d5Pn5mIM!
The person auhwr'na]b MBim the tlgmaM rammed MMe Mainland Man Ma(Morro a'.
Name: Peen I Demmwe
Address T Sherman Amnon. Caimh. W 120]3 share (518)ina 385
The uemsmd charm or MaasM all be rage of an Wood.
SuMI 'm St fall Cgmekry. fourth W
rib are ream day Person named ben dean col tee Puueaam a MaaaneW remains.
Plena'Counse m lsbAlOaMwglee IC4 WM
Ma remaMs m December,wn.M Hem., ten by deuvay
n pemm An W repeered mar ae+r.ee.ea
tan A WW
gwwaoma
ODS18mf(RW 08115) Pgy°S°1S
Authorization for Cremation and Disposition
�L(mma me mlesi
-) �Aft unaertdna had if Me renders are not divined aitlM 110 days HYemBOM,
Pirewaw CremalMum men diepuw of fore demand in
an comment manner. such as by[comenng. ✓cm«wn
CMAI ITION COM>I NENONN
(I ONE dMe morwmgl
>-�An um to M sand as acoMniner for Me Gemeled remains NS been Wrch06d M1P'n Doementre FUMBI Nome Inc.
and is described as follow[ Md/i..n i, . "1,1 C- I +,,4 MwnwQ
Ii uMentand flat 9the um I[bo small b hot Me entire downward remade, m handsome rgid container may be used for delivery.
-0E-
_Mum is MyelryNueM. IM'eurMemlaM Mailm ones pxNaW uolhxmwgovitled
Pmevbw CremalaWm
nM �y veal platy MOMmetM interim
a rigid a mpwmy conleirer for deywry
This AUModbd'm Fwm aa[proved by ecbXs Odvmre "a exxWad al
g�.wnrx..0
Oensmare Finenl lkme, In[
i SMman Avenue, Center NY 12M
and is smell by To Nrerzl der ae vM Sto it[EmGmrd
II have ameivM a competed chary of Mis AUNorlaetlon Form.
The pnoMe)IdxNMd below WIT he p n(s)In wninl of diepcence,Wto by aBnLp Mb AUMonze Form.daemon
In she accuracy and complMtion of 1M irMmarri ewtbNW In Mb ArMwb Form and aNhwlaefe)Me forpoing.
SigI ban IM able,of Judy . m 30�{ f \ C
204 Rwq G, Cmdri NY 1=2
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MNES
metal
Cnwioner .�
RCben L OMdmore
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DOS IMW 1(Rev.W151 Ppe 9 ol3