Armbruster Jr., Howard P. Pine View Cemetery & Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (518) 745.4478
FUNERAL HOME: �' IYJLOJLLC_- __ RETURN TIME:
DATE S TIME REMAINS ARRIVED AT CREMATORY: IIID 3S
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
ww
NAME: — 2_pPITBDU/qy y '''.I CASED 9I6
TYPE OF CONTAINER: G(LAI p{- .µql
PLACE OF DEATH: 138 {[d ,G,y er1. A 4MM4,q 11 17431
ESTIMATED WEIGHT OF REMAINS S CONTAINER Z1G (1
PLACED IN HOLD:
PLACED IN REFRIGERATION: _
DATE OF CREMATION: (PI( N
TIME STARTED: Y•r0 AM TIME COMPLETION q Ihq ��MYM(AT
PLACED IN RETORT: o:m An MOVED: /••4P ITII IIzO(�
� ale
RETORT p IN WHICH REMAINS WERE CREMATED: R.L p�1- [L
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOA SHALL OF RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
Now
DeMrbnentok u
NEOWYORK Division of DNIMMN OF„EMETERIES
Is7AT OF orewmmara Nma
Cemeteries
"�n,Ne7aauE
Authorization for Cremation and Disposition
mis ANh on FormmatMeomple andelgnee Prlo.b aelleanarem.ms roramn.aM.
Dam,.. 07i3Oa020 Number FI$
CrsmaMry Name'. Piney CMNIpy
PLd,ess, 21 Quaker Road O membury.W 4004 PNcm, (510) 745,4477
CREWTIOW$AN IRREVERSIBLE AND FINAL PRDCESS.
Crandon tarried out by playing the remains of the Minimal and Me consumer holing flow ramtiM imp a barrelchamberMve
they are sure Mmin@nu Mat and flame. TM but ant Name will lnciMON and MMuma ant ing except babe and bring.
M"am all ux will M IaM1 After cmnaon.
Following cremation the uemat As hike rasebal de Nbfts 0 ounces he will M all of t ns arm materal immtie cnmaNxi
chamber, bbutlw sane minimal dust and muds win Iry Mleft behind The cMMlory MII wpr inpdannl and kreren meleMl dam
NBIBmaineantl InaInpbmHl and breign material All M thinned Mai required by lax. TMaema RmelnsmllMtalelanimlly
inhetivd Inn smell papas and placed rhea a designed container or um. Cremona mmaina genanlly are Wlndmd uwl ne
sinew fragment N recognizable as skeletal bsue.
GFENING OF THE CONTAINER
The cannel may mill Me wnuirer holding the uncremated human remainsin Ironed countenances,such ad to cobir tw
k of Medemased or benure Pet no mawrim is endesed whim might Injury Armeyms ddemage the aematorygoMrly. N
human remains are dellnred Ina container which Is not suitable for cremation with by Mremomal or rental call thy,
cmmna will mall collie remains be mood tow a aainbcommonlyMrore it scM cnnusr pb lie remains. The tyBnirre Ma
mriwinerry crma o-anarer or nlmnl olremaina vice ba wneuclel hewre.MNms end tan badoM In p h'aty, wIP dRniryaM Iespct
IDENTIFICATKIN OF DECEASED
Name M Decsawa. Howard P.M =d ..h Miami Slaws: Droomeal
La&Nrwn Address: bur PLiraMeG Circe, Genes ,NY Ia31
Place of aaP: 13A Adrenal Cntle.GNINwwrl W 12VI
sex: On nF Ape 75 D0809/27/1944 Dowd Death: 07MM020 Emnaw mw ft 220
Duarphon ofta Umntailmrin ow AM remain AN ba deliwaM.
Cardboard Box wMboden Base
PERSON IN CONTROL OF DISPOSITIDN
(PeraM(s)m cwtrd Mdspsflm, age oNEdlhe Mkcwingl
I amMB are the dnigirl a9anl of the demo dagnabd P a MII or union Instrument exwdd Pursuant to Public
Heats Law SBNon 4201.
-OR-
Ayr IM1Na hen no knowledge plat be Msawd exacuwd a woman Instrument pursuant to Public HaeM Law Scamon 4201 ma
well actin Maxicare Im the dismsMn of he or her remains and INre are the pemn{s)hewing Priory under Pubic Heald law
s on 4201 and how Me May to well common o1 the remains of MAY dacN Mylour relationship to Me Mcne"As as
failure
Howard P. Armbruster, Jr.
DOS-109ALF bew. bull Page i of
Authorization for Cremation and Disposition
nrearrmarl Mrueamp)
Neutral� N oaaaipoon: MMNaa'An^dunerlson)
1. Apeisan enigneW lnwrNnp WrauaMlo Publl[XeelM Lew$eGIan1201(8);
2. They surming Moore,
L. TM aurvrng domestic peNrer:
8. Any auyl child mill same of who aaker.
4. Aformil parent
8. A¢uMWng sibling egheen yeart W age a olMr',
8. Aal ly acronym Mandan',
T. My perscned agrees,years of No or mail gplbe M Mal the estate and and Were cedar l in McLurrom 0 hedeau0d;
8. A duty appolnlN fiducary of The rarer¢',
A. Adme M1'end or Forthue woo Me executed a waNBn atabmenl pursyinHO Pudic Health Law Section 4201(2)',
10, A chi fined olfvil or a Coal 0r 8 pW`c aaminlal eppOmbd pursuant M the Suayep'6 COUR Procedure AM
ran. Any other mural who is among be balrch of the deaasee and who has exmMe a will octa rat pursuant to Public H
Law Sean 4KH(]), d i;z-k
(MANALL MRSE NMe bPOwing) �
MoC IMy Mrepy afirm Mrt Ne bWyofnwaexmee ems nmroMamabatlery.bevery petlr, pouermu. radwc4rre lmPlent W�
or rascal covers and Nal a"soon maraiare wrte slowed pror For the mend on of his Methanol PC ijumnm vO
mass items Prior io[remaaon may result In him W Mu[IemFbry and crememn wraonaal. 'M` ��[[�E C
fry IAW BFmn Mat iniWtllary MW bum been to Rolland G Hoeg
regvemg W removal of arty PorsaMl pr;eM Or Other young or sell whoor any prawn signing berg any hardly manor of the
desaaed vnaaaa In premsay, Pere Ywi Cremal
I¢nMresPorelbk tertlN mnaval0l Porsamlitems M1Om Me mrrpeneronc�m tM remain901Ne Eeoiaeu]. Fema Home IMIn Me
eeeral or all Me remains sale W destroyed by Me cmmalM process and cannot be M m On reved May cmN .
—L M horsbyauMorizr PreYiex Crematory
m+=euv M neonate Me remains a Me decarsed.
InlNaI OPTIONAL)
e named finumal
for
matery.Mare
eeme moral rylnMe opinl na melWn nal ddracbdi.and blamnd Mile term to p made the correct name and
um
addm¢or such smmeN aramarory.
FINAL OISPOSITMN
The oral enhanced TO r mMr[ SM aanNre ot tln deffea¢ed from Me uanabry Is:
Name: CompmAonete Furrerel Cray
Melva. 4412 Maple Ace.. SereMge Spays, W 12� Phone (51MUM-4844
This uem ranaln a Mnmed will oe Olwrem of as bili
Realm To Family
If our my rnson For mxan woad above does nth la pwuetion more uarufre m mdr
rates crmlamry is awranme M gi pce¢uon of
News
89 Rmamto Cemwsseonae Forced Cam, Irm by dell
In perm or by rgsdrl mail. T�sexvmremx Hut P. AnnumalerA
O0S18g f(Roa OM20) a Pmga2cf5
Authorization for Cremation and Disposition
(IL12d Ne lglowMyJ
'y%_IAW unE9srBM Maiifpe remelne BR MI daimeE xNnn 1MEayadortmeppn,
Pere Vow Cremaory
wre.an may diywe.of me owners in
an nremavdle mangs. aJw as by eRnennp. r
GREM nONCOKMNERNRN
0 Ip fld ONE dine meaning)
Art umfo W read as a contaerer for they barrel mil ban bean pnMamd bam
and is essential as Monte;
IMb seasonal tad true Jim is Im small W MgtlN some Decoded Moral M adJMOral NW Mtbirer may W ubd Mde§wry.
�.�ran um a nar Wo PJRtuNd Il Understand Mad of none um is puTaead oroneyrova gwked
PIM vim Crematory vAl (Aare to aRmated nal in
a and nmPOnry container for delluery. r. woanww
Tho,AWwN n Fcrm wer ptn^ded by ROOM G. Hong was exal at
Cane ore Furerel Can, too
401 MW Ave..Bnyto Sponge NY USES
and Is egnM by May Nnenl OrxNrin More¢¢to lLL emcNbn��e
IAW love raniva] a compkkd copy of Nis AuMorhedan Form.
1M mnoWs) MenthMd below Were Na Mail In control d dlspnnt"a by elpnlnB this Augoma0on Form,a gs)
N the accuracy and mmpN $W Me IrRarmadon contained In NN AMWIZe From and auNor s)dra/on l".
Signed to 10s6 day Jury ,2020
Mntraw Armbruster
17 Ryana Feel Road Co imm. NY 1$1123
WRNESS:
ROMI G. Ilep (I--
wnvArt'vtwmwru wa
tt8J5
Ncwnd P.Mbiu¢ Jr.
WS10961iRay. 0AR0) Pape]W3