Slayton, Karen Pine View Cemetery 8 Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL MOM ID _ _��_� RETURN TIME:
DATE B TIME REMAINS ARRIVED AT CREMATORY:
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
564AW YWLLU
NAME' &PWQAlTW Oil
twee P
TYPE OF CONTAINER: FlIN LEFT ,/c.k v /krj6r-
PLACE OF DEATH: /aI F FC� i TlFylk —
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER1
PLACED IN HOLD:
PLACED IN REFRIGERATION: I/ 40)t1
DATE OF CREMATION: /�� 7(/I )b
TIME STARTED: _ 1 l'WP NI TIME COMPLETED: .1w/_D'��
PLACED IN RETORT: _ '7:44Ail MOVED: Q qA —92fM
T I 1 �
RETORT p IN WHICH REMAINS WERE CREMATED; (ILL! (1pyQ
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN GS HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG Sxqu BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
New
miSm,
sTMYkWYORK Division of DIVISION OF WME}MXES
Me n
Cemeteries sh,tan^Ava^-
�r
Tale °MINC4a„a
dmmpa.
Authorization for Cremation and Disposition
TNM AaMarManan Fam mast M compleertl ane siprrsa Pnorm mm.ey M maim roe cnmeuw.
Dale: 07112I2020 Number.
Crememy N IMAPine V GeMatorium
Addrea:51 Quaker Read Queensbury, NY 12804 phone: (518) 145-e477
CREMATION IB AN IRREVERSIBLE AND FINAL PROCESS.
CrHMlinn is carried out by placing the remains of Me,Eeceeeetl and Me commence codes IR remains Into a aemcPon MNnCer wr
than an submalee to Intense May and Fame. The roal and Nvms well Inclnx and consume ovary in except tents and MM4
which an all that will M WIN ear cnm"w.
Following Ucmetion, V4 enmamry will take reasonable eXom to mere ell ofMe remains and other materall M1Cm the owmpi
chamber but some minimal dust and me dus will IIkey be left CMiM. The claimants will Npemm ircMerml and breipn mawmi fM1vn
tot remains and the incidental and bear balance MII M diNm9ed am renulred by law. The aerated remains will be mechanic ly
pulvenzM inn small pietas and placed Inc a deMgna conu urn. Cr WnmvlmgsnnvlhenpulveLL umam
single f a mat is ncopniable se skelW I Nearm
OPENING Oli COWMNER
The cremamry may only open the container holding Me uncremated human remains In 4mted circumstances, wN as m confirm the
attorney of rot damaged or on ensure that no matenal is endown which mightmiemployees or barremelM CRmaam pronely N
human remain en dallwred In a wmalmr which Is not Number be cnmabm such as cemmnlal n nnMI wskM tot
emrywMrpuln tam alofm bymoved inmamiMMecoaM eMore iia don on nmtlm. Thenl nWdofa
ConbiMmor Me penehr a mmwel of mains will Ce conduGed Ltlbre a wMme end MII[e done In pirvary.NYN dgnlfy end respel.
IDEMIFICAMON OF DECEASED
Name N Necessity"ran Slayton MaMiSMMs: QIVorCGd
t.N Krawn AdareM:a.+ nJ¢edl � P2sv. C � rcle 'L3
con M Deets.Glans Falls Hospital, 100 Park Street, Glens Falls, NY 1=1
sex: OM ® F Age: T/ DOB; 04110,1943 WMMOmM; 07/1112020 Eabmletl WsighL
Oesapsm al ukellmnnimr in which r In will mtlNiueretl.
FiberboardlahemaOVe contairder, MettOews Company
PERSON IN COMTRM OF DMPO&TION
rommafddiapmdun �oNEaMa roxaneM)
/ fai 1emM/e are lot coastal pal of Me eenemtl ewgnNm in a will or written instrument"e purewm to Pubic
Heenh Law Section 4201.
OR
We have no kmMedm May Me Methanol canceled a wriaen msbumem minutes Pi Health Law action 4201 or e
as conning directions In Me diap Mon of his or Mr remema am the are Me penmp)haairp pnmily under Public Heahn law
saMn 4201 act hive the bill M aumonm cremation of Me Damon of tot mac , All nlanonshlp to the Moment Ma
Against.
Karen Slayton
essirs
OOs-t066f(Rev. Mot Pagel 03
Authorization for Cremation and Disposition
nn ed mom me xn bear)
Number'. A3 pescrad : Suryivint Child
1. APorem demanded in where Wrauant to Poole reason Law SeMm 4301(3).
2. no surviving advers,
3a. TM simming dOmem4c paMerl
3. Amy summing Nis aerosol years of age or doer
A ASUMN09 perand
8. AsuMv',ng adding eighteen years of age or odic.
8. A shortly appointed powder,
T. Any(geacts)OigM1leen years of age or olds eMllM b share in the estate and who bees creeel In RlaOensi ip b the dtteobi
8. A duly a ppoinled fiduuary Me dbe:
0. Aclox Mend or relative who has advocated a wnten statement pursuant to Public Heats Law 5ecton 41
10. Achief fiece l officer of a county,or a public adminiYMd appointed pursuant to the anneste a Cord Robert Aa,
10a. Any other crown who is aping on pmMM of be tlewawd and wM has executed a whom statement payment b Pi wasom
LAW eaion 4201(7).
I�AU HREEaIMNgOwing)
'hereby aPnm Met the body of the dBuemd tlros me contain a barey, Mrory pea,prover fail, wasolo eincyl
or redgechve device and that any such moderate were removed par W Me common of tMa AUMM Form. Failure ¢now
77 cylindrical.perrocn ton may reels In harm to the compulsory and uxrubrycylindrical.L roleakm Mairntad'whw hew Ewen given to Sarah A. Philp
regarding she removal deny personal compMy or other thine or value which any answer SON MWx a sry family m rq be
defaawd wimhea to precrve. Pine View Crematorium
re na reepwhdLl.roh tM remwel oraneomal ioms4cm tM whhemer o;fam Me remeimsa Me de«seed. Pawohuf form.f.rtm th.
hit xllh lawayremains win M dMiryyad tar era corrosion prcwms aM cannot way hgX after cmngbn.
/L` uwe Mr yaumoree Pine Yew Crematorium
Pin lower- lM rmuma glMdauaed.
IngieICPTIIXJAq
for heeby aumorlw the named mnewl MrMor to proNde for danvay to and conservation by an sMm,h
Cpmrbry. N deemed normal in the opinbn of the Nnaraf vacuum,and m amend the form to povide the comedy name and
aadms M such summer,CMMM y.
Rall OIShP Spl
me parson WM to chances me amended numers of my discovered Mm the mrnall u:
Namur.Regan Denny Stafford Funeral Home Sarah A. Phllo
Ammi 53 Quaker Road, Queenebury, W 128M PMM: (518) 792-1114
They downward aft a moeated will the deanxdi am bodies:
To be retuned to the family —r Ai QV\ rRtr
If for any rearm the person named always coer M We paeeubn dbe vemsbd sememr,
Pine View Cfemetadum a authedpd b give possession at
the remains to Regan Dennis Stallard Funeral Home they delivery
a.ex.e
in pen oh registered met Kmen Slaylon
WS-1891(Rev. 0440) Pge3 d3
Authorization for Cremation and Disposition
IMb undet&vM treat iftM Memineart M mimed wNNn tm days determined
Pirte Yaw Crematorium may depose of are rtmads in
m awmr
an irMdevabk mmner,aucbxsyewxnre. i
CRFIYIgN COMNRERNRR
(1ppIy ONE d nre fdMving)
Ragan Danny Stafford Funeral
M um to be wed as a container for W oanered nmeim has been Wrcbawd rmm u—...—
and a descried as Intense
IM1Ve undxtend Nat it Me use a bed enal to tad any mart aemabl demands, an aYAantl r id mrdeixr may M wed for fthim .
+w�{
X yr( Mum is mlyelprtcaned. aWeYMersbM Malgrp YmbsvNaxtl YollMrxVBgonEBd
Pine View Cxmatonum Nql pace Ma oemmd mneim in
e yid remportry Wnulnerr«MnYery w- ��
The AuMwaedon Form pea provided by Sarah A. Phib weaa.enned at
Regan Danny Staaord Funeral Home
earn
53 Quaker Road, Oueenebury, NY 12804
are is aq N4 Me Nnenl Mmtld as witness to as esemtiion
lMe have recelrx a competed mpy,of Mis AYtlwr4atlmt Form.
The peMonte)tdendned below Water the panmb)in cmrbol or dapaalaon, and,by slanbq that aYModvaon Form.altt
to the Accunry and Compassionate of the Intwmedon embtned M M4 AUMmtrNws Form add augodu(s)tM Mentioned.
alanedtha 12th dayof Juar ,m 20 [,y
NO tw rCpl� S'F . IAA tad
l '�1'sY l(.�T10hOr Q�l hh YYQ Cf) I�
t +T 1ny� tyy ^ Aln( ry
seem
yIITNESa: �
v.�+nmraoraamv Sarah A. Philo 'gib-pt, I^^�^^ nn
ma 12RRg
Karen Sheridan
ywwaei e
W0 19964(Rev. O440) py6]p9