Schottke, William F. Pine View Cemetery & Crematorium
Quaker Road
QueensburyE NY 12804
(51a) 745-4477 or (518) 745-4476
FUNERAL HOME: ____ N_ . _ RETURN TIME:
DATE 8 TIME REMAINS ARRIVED AT CREMATORY:
NAME OF FUNERAL DIRECTOR OR REGRISTERED REBID
EHT DELIVERING REMAINS:
NAME: _ NLU r XUOII /E / CASEY_ 84I
TYPE OF CONTAINER;
'/_ i�AK LvV/t^ IC d 1k 1 AGAIN �
PLACE OF CENTRE In K[ISWS PI Ayp ) PIt
ESTIMATED WEIGHT OF REMAINS A CONTAINER_
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: -7/70 I {0 ,�RLLO�nnNBLL..TIME STARTED: _ LmFn TIME COMPLETED: Z;-•rll
PLACED IN RETORT: loin mave0: q Z36PM11 Z'60-R)
RETORT C IN WHICH REMAINS WERE CREMATED:
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE THE CREMATION LOG SHALL BE RETAINED IN THE PERMANENT FILE BE THE CREMATORY.
NEWYORK i)IVISIOR Of nry bPIMNew
„Years
of Worn
STATEOF Iswx oECEmFrsmes
°"""T"" Cemeteries rew Coast pall
Ta�,.Mainstream
Authorization for Cremation and Disposition
Th"Aua atlon Form must y completed and sgnM prbr to ft W amoans M omldlm.
July 18, 2020 Nuclei
CTaminyrl fichlessigher cligidgithizzam
AWresa: 21 baNpc3 Warm bucEOrn�ey� u�pl„t: l6 r
CREMATION LSµ$M"ER31BLE µ0 FIML PROCESS.
CremaOm B cerise M by yJxlrg Me measures at dxewh a and tell mstruser MM Imo the theme was a cremaXon chamM M"
they are ausemM to Nets held ant Oame. That,heat and Ogre will Incinerate and consume ewryMln8 a othat ant m"L,
which an all Nat MII be INI after,cramNum,
FdlonanO chances,the uemd ry WHems reaSmade merge to raises Nl male remains ant move member from day
chaminp but geothermal dust and MJlpvAll lllany tea lee behind TM1e crematory¢nll ¢epagaleiMdenblaM loragi makd&M1on
tM remsneaMNa Ntidema any lm&onm wiu bmdi¢uo¢ed of palreread rm¢mar d�H am paw Imo at0�ilPtiM Wmain««ared¢r. Continental
mmems,ere•generallyeltlly re ame pete rMn bd and
m Or
nelmtaPmentt.mroynlublo...kelew door..
OPENING OF THE CONTAINER
Thee Oy maymyover,the buyers belong me,mr,mmamd than,,remain¢in rmaeb cmimmucees,¢um as lO Whir,the
moratorium d onto ensure that no material is mclostlw ,itll mioM1Lmirre employees or always the amretay PMWe rc
human remains an dellwrtl In a comma.whim Is set sulleme for mramauon such we ceremonial or areas oxb4 Me
mMsabry ii require Met Na revealed was moved Into a suitable commm,same,ttaci the remains, the rummy as
rm a,the transfer or rennei aremgt me be mMu bed Wore asawares and earl be alone in always,sent Mary and rmpct
ArwN OE D99MDED
Name of Distance: William F. Schottke manta stews: Widowed
Ltlt Korea Address: 47 Kelsey's Pond Rd. r Fort Annr Ny. 128D
newaoaaln:
same
a3 above
stry Us OF she: 73 bas: 07/14/1947 DMwO o: O7/17/2020 F mead Weom'.J1��
ac Aplirn acakeVwrtlarlxln vTM remalna Wu be aelluerW. Florence Casket CO.
,ammue. ra,mAconglaphysitly base, Cardboard top,
PERSON M CONTROL OF DISPOSITION
(Pa3M(3)in roast microwave, total ONE of the mlbsers)
I aNWe me Me sought went of tFa dmaaed CtY mW In a wal an MtleeIMnmml wa Wperceived b Pubic
HeyM Lea Seclm 0201.
INYe herean kmwladoa Me Me weaal ereodtl awman ImMrmant pull to Public Hat Lax Seabn U01 or a
III mnhwirg dimcpons ter Ma dmtailin m=o7or remalas and lM are the payments)her monty under Fublic Heat Lev
S n 4201 and Immigrants War uncommon mass gemat bureaucrat NylOre,lati,mhipbMetleceesedlsas
blare:
William F. Schottke
were,sawass
OOSlissa(Rev.cars) Pali
�• 1 Authorl ition for Cremation and Disposition
(mamwmne tiasl»bWj
Narcissi nsaiplkn: Cla1'E FlbLCflO
v ApmonamrgS=n whiling Wrauemlo Pock lkpnn Law SaclM 111;4m
2. me¢orvrvlrg peae',
2a The awvNlna mamesh panne:
2. Anyeavivirg child aBmmn years a OR,On clear'.
a. A¢ohewemfroul
5. A¢uvil mooing elymeon years of No or W¢c
8. A yfOu eR elghtco,years
PnypersonsjedPlac Year¢ae0ewd0er anrMlm I,chase In Me mlde aM wtq l¢Iare tlosssl in relelbnMlpbhierbamqB. ',
W A code found
Places a of that eonora
B. Adid eudl ahis Of aGr M1m ereMetlawdlensor am WBuadbPWlk Mo the urrome Law SxWn120111f;
10. Ayother aarsona la wonly w a Public andof the d¢tra iAnd are immunhalt
Wa%dWX1 St CWt PaiddeaduPureawa Pq
10a. Paw dlgrperson win la acling on brd(INtm Oecrosen mOwMllm a`mWawnpwl alalarenl pur¢Wn110 Pu01lcXm101
IaN9ection 4201(7)
! AhLL THREE of We Andoeast
/JMYo0IMle for drakes Me MOy dhie 2n®net Coal a Mindy bypgy pyy p¢µv mil.rayWc!e lmplam
or raLmclee neyiw aide not Any much ma Nds ware mrpved poor b WO eeecutmn N this AUM aG Fnmr. FYlore to mmow
thll; iQrn¢poor to may mauls In harm to Ma wmtlory antl o weaddey pereennel.
((/uw/^/✓/(Ry//!1`,1�w me All mot'etrctvhm lave lean given to Bruce K. Masonr 12261
ry IN the remowAl of am parsew properly or otnm NLg a wane MMh am pe'¢uh¢Igmna lebv a"mays maMe a Me
deam¢mmetal to praene. P. ffJ
Is rM rmpslb sA kin me the ala[mar mal sere frond the GMmker or from the emaOw 4 Me emtual Pennnal ham¢left In hie
nW ea/r or ease We nmana will us d uAmsi by the arema0m Pia¢¢ a a and cnnod l Audi ewer wemabn.
t�Imre M1enbs aANarne ftl1 Vl
prnO,Neal
is anmefe the ra min¢a to dema.aa.
FINAL o19Pos noN
T paean y,morlmtl b recWe hie vemtlae renam W as aecesd/nm We vemebry k:
Name: Bruce K. Mason
Addrem: P.O. Box 277, Fort Ann, MY. 12827 Prone; 518-639-5252
Inner wa remelm m daw¢ed AM the aapxal Of m lNmm:
Return to family.
It As"Mason the mrsm woad a Oar MI m mbn At me wM m.
CNASmL. I¢aYnrzalb MR,p m¢kna
"Mane w n F 1 H m gddNay
In verso a Ey ryieleral . In...hw w..
mas
William F. Schottke
005-0B96f IRev. 06'151 Pa2e2of3
i
Orr�.�A/�u/�th�orlution for Cremation and Disposition
.A,.y
w+a tme Nm Ifft ronaim inemAdainvoi,shm lMamdrremabon.
P '��� maiemWe.a Nemmainam
an 'whonevaek mann«,inch as by SustMlp. awa �vas�
mle9F
l�oXEmNerow�npinaa
milh toC n asa=UiwfortM�rmWiehmb WltlWea M1om
ane Inarumaa ne fdwa-
��vwaanaemaneud RNe am b mnamaf w nda me amha«anmaa,.naiw an eaem«mI pia aclx'nmmay be�eearoradNay.
(�yQ�M«niaMpp W�alas/fea. 1'WeuMasW bN gmunleNa ordMn'neepmll
vv I 0 Wlpay Necremaltl rertairy in
a.aid tam W ray Panbin«I«edNmy.
TNCANhvaalbn Form wav gov'vle]by Bruce R. M89Onr 12261 wmeMMai
Mason Funeral HomeIn rPQrftA St . . Fort A
Yww
ane ie eyMa by Ne lurs2l airecwr p wllnpa b I15 exerull«I.�etlim
Me hrva mcwve]a amplated c W she Aumodzothhn Form.
TM oultsaIaenN babes Was the assets)In contlol of asposiaon,who of SIPIp this Anrar4tlbn Fors east
to the accuracy she co ostene»W the Irformation contained In this sedimentation Foam and the bmpW'q.
9m atnmi :Yt z ,M90
7A6 Nov Fnetnn PA Xamntnn V' 12832
naeavmwoww seaman
WITNESS:
cap
t...a«.�� ,. M.....-.N
William F. 9chottke
la�wesy
003-1096-f(Rev.Mist Pga 3d3