Dixon, Norma B. Pine View Cemetery 8 Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745.4477 or (518) 745.4476
FUNERAL HOME: _ -F,05 RETURN TIME:
DATE 8 TIME REMAINS ARRIVED AT CREMATORY: -I/Ow Ij'li$Qh
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS: -
MAILV D IMBI E.
NAME: 136MA `aaA) CASE p0_
TYPE OF CONTAINER: Roth(
PLACE OF DEATH: An 4.1_1(_ li^4
ESTIMATED WEIGHT OF REMAINS 6 CONTAINER_
PLACED IN HOLDI (•m
PLACED IN REFRIGERATION:
DATE OF CREMATION: 7' 9-7- w
TIME STARTED: 113Spm TIME COMPLETED:
PLACED IN RETORT: MOVED: IL-14II; iLWI)�h �:lo
RETORT P IN WHICH REMAINS WERE CREMATED: I7yuk/'P✓IY
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION Lao SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
DePoMwnl W4$11,
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Authoriution for Cremation and Disposition
This AUNor Uda Form mbar br complWd awl a19had proof W dON ofn mla museum.
NW, 07I07I2020 Number: eo
Cmnamry Name:Pine Ylew Crematory
Audi Quaker Road, Differential NY 12804 Rhode: (518) ]45476
CREMAMN I6 AN IRREVERSIBLE AND FINAL PROCE38.
Cremation is cargo old by abating Me remaro d the dacSW awl Me co er holding the remamsam a gematim dumber mods
dwyamsubp toinl wn taneflame. Theh and flame will lnmormy and consums emryMlnO eampt bum and n 1,
much ere all that will m Its offer cme on.
Manuel corrosion, the Crematory will take reasonable e1rOm to mroM all of the remains ear other material from lee aema0on
member. but some minimal dug dap residue will likely be lef[Mind TMcremNa lleepm ind "leMm gnnatedalfmm
its remains awl the ineNenMl am foreign materiel will be Moment am nouiretl of law. the cremated remain will be mechanically
Wlvedmdlour,smell pieces and placedInto a recorded consul um. Crumbsrmulm BenmlryemwN Wumino
aingmhegment Isre nWbleasekNm$Num.
OPENING OF THE CONTAINER
Into crematory may only open Me combiner homes the uncremated human remains N crooned dreumsmingre wch as mcorifimtln
identify of Me demuel or re Met renal is enclosed whits might injure emwoyeas or damage Me aemMwy propem_ N
human mmalno am segment In a consul which Ie net gamble for cmmatlon auds w common lot«hiring m.keR Ma
crematafr will re9ulm Inel ue mnaw be moved boo. aunabb mmalm.Mm ne[mpb Mo mmelm. The opermry W a
ordainerortln ttaroM or remor.l orremaim win be cvnaucdd damn a wHnm awl wtn oe eons In privery, with d'gniry awl mend.
IOENBFICAIMON OF DECEASE°
Name W Oec ae Norma B Dixon Miami Si DiVIX
Leg Nmum Mdrem:96 Sheridan Street, Glens Fells, NY 12801
pWMONM,, 96 Sheridan Street, Glens Falls, NY 12801
Su: 13M OF Aga: 87 DOB: 0712WI932 Doled° grill Fri w"m: ql)
Dewiam du Wmr iner In who mnine yell be dgiverM.
Bul lO Casket Co —Alt cum diner
PERSON IN CONTRM OF DMPOMN
(Rmmn(s)N conchal of siaµunion. jorgif ME Oft MMInpJ
emM1Yem are dmgreted agent W Me demise!dm Win a will or n instrument measured pumuem m Public
Health IYx Shun 4201
-/OR-
IM1Ve have not knowledge that Me tlmeNd ebedad a written instrument Writs nr m Pubic much law Sa[tlm Your or
will demanding overseas for Me sums n of his or her mmains am IM2 are the Me (s)modom Plaity uMm Pudic NeaM Law
shim 4201 and have the rgmm aMorpe goalm Ware remains grim segment MyNrmWOtl ipmr l� Mm
kit
Norma B Dixon
MS 18984(Rea 04120) Pace t IN 9
Authorization for Cremation and Disposition
nntt9xn Na hf ba:ow)
Number 3 cesopnon:ChiIE over the age of 18
1. A pemnOngratW in ambol pureuanlb Fubf graph taw Stephen 4201(3):
2. The eurvrving spout',
2a. The showing domestic pawner',
3. My survrviy cost element nature of age Or due,
A A surviving parent.
S. A aurrrving holing eighteen yams of age or oker,
S. Al awfully apaimed guardian:
L My Mmi eighteen years of new or older added to share in Me dale vp who screw coal In relabonship W its, M]:
9. A duly appointed fiduciary of Me wage,
9. A cent friend or relative who has ecemlN a written mitemem pumand W Public Heats Lax Samon 4201p1:
to. A Nkf hot olficar of a county or a public administrator amounted!Wrsoanl or the Stumpage S Count Procedure Act
Va. My other Person who is worse on baMN of Me daoretd and who Ma executed a nrlXen slmemenl obscure to Public Hwllh
Lee section 4201(7).
(��ALL THREE W Ne kVcvMel
Me rmeer affirm that the body of the deposit does nor"can a battery, beat pack,goal call, ra]Iwaiw imgam,
orredlretlNe deW"nd Net any suN naAdek some removed pnwN the etcWonIXNb AUNt(talbn Fpm. FFlluwbnmow
riarme/b� ro pMrb cnmeron may mull In M1erm ro1M[nnretery eM[renulary gwmrol.
!)-V IM§afim ma'nawcrons nave been givenN Me* J.DDeSSiimone
regarding the removal of soy Nownrel property or other Mindy of tit wNM am parsm signing bebx or a"floppy member a the
depoatd wishes W preserve. Pine Vew Crematory
is nth responses for Me removal of northern Items from the tMelror or M1cm has remaim WMe dettN. Pemorwf Xam NX In the
�y roamer or whip Me message will be destroyed by the cwnmflon prate and canna be wtrMved beer mmo4
bore M1eng euthonzo Pine View Crematory
p..rw"we
to cmmme My im of Me,dxrbed.
(L=10PTIONAL)
Its hereby aNbator the named MMOI dlryctir M Movies for denary,to and combstion 4 an aMmme
clonernory, Ndtmed necessary In Me opinion of the funml director, and to ameM MIS firm to erri the roma name pod
atldms Of such aXemeb crematory.
FINAL 01 n"CuNTION
He person authorized W reuse Xe oernsYd remeim INNe remained hem tM umMlay b[
Name: Kevin Dixon
Mdret. 137 Hunter Soared, Glens Falls . NY 12801- Pnpne: (518)74247N
The cremeted remmns a declined!we[e dupotd W thlowl:
Burial at Momirlga'de Cemetery Hartford NY
XMam macr the pewm owned above hn rMtake p on ode uxreYd gmrelm,
Pint Ylew Crematory is authpdzed W wive ptsetian a
wmmwnee
Me mrminsN Regan Denny Stafford Funeral Home by delivery
In or by rBpleMM mall. Normla B Dixon
C Itches Fear, 0 O) abw Page W3
Authorization for Cremation and Disposition
Iwlalum romwMpl
aVNC wa¢wdMNnne rem.ine.re rout wimdaahM ,zo asy.ur¢remaaw.
Pine View Crematory may aydoe ofti aboard; an
wad.�p
an IrMywebis mdende.„„h as by dwtisdrq.
CaEY M COI AINEWRN
yIMW ONE Mthe tottering)
Regan Danny Stafford! Funeral
M urn to be used as a wntairer for tM vement remains fa been µrdesed from u_..._
and a disturbed as follows.
men uM¢Rtand Mat 4tle torn u tm urns W had Me desire mewled remains.an additional red mnWner may btu used for Wirely.
F-
'L An um be rid ye,quduad, It understand MH R W um is foundation!«dMenWe prooded
Pine View Crematory ail plaid tte cremetd remeim in
p..amm�
a rigid temporary widener far oNivery.
This AufaM Form wp gWpd by Mark J. Da$ImOna "a ex%utd at
Regan Denny Slaii Funeral Home
M Quaker Road. Dueensbury, NY 12804
w..signed!ry M wal is slpnea fun dreams as afrwomento Its common
Me hard renter a completed wpY of Mis AUNwlas Form.
The prowls) handles! beat Imam tM penamisl In co coed of disposes n."a by signing Mis Autlwrlcedon Form. yesterday)
to Nx accuracy and complarenrs W that Informal caMalad In Nb Autlwrliyeaon Form and eubsor lel Me bragoln .
gigadgy ]th der of JUIY .20 20
Kevin Dixon
mea.a..a.
137 Hunter Street Glans Falls , NY 12801-
nw.nwa.. yew.
WRNE89:
Mark J. DeBimona
. .re. w ryn n
0919
Notably B Dixon
wea.—r
W Iiaw lase. 0var) Pryp 3 of