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Woodard, Amy Christine Pine View Cemetery & Crematorium Quaker Road Queensburyl NY 12804 (518) 745-4477 or (518) 745.4476 FUNERAL HOME: _ gFyiN� RETURN TIME: y DATE 8 TIME REMAINS ARRIVED AT CREMATORY: ... NAME OF FUNERAL DIRECTOR OR REGRISTEREO RESIDENT DELIVERING REMAINS: __. mAFY Qp�311 NAME: ._ AMy A. 1I1�°D AQ� CASE R qqY TYPE OF CONTAINER: ^I<NW�I1' wood 6� I Nt .� PLACE of DEATH; )4 �wP ({rou I Q ,.. I,PIy Yh NO 1 ESTIMATED WEIGHT OF REMAINS S CONTAINER 3$b (L{ PLACED IN HOLD: PLACED IN REFRIGERATION: _ DATE OF CREMATION: 7& I w TIME STARTED: _ [DS TIME COMPLETED: 2A-0IL1 p1-I PLACED IN RETORT: _ 16en MOVED: Z'3�Qn Z�SOfII RETORT N 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 OF we CREMATORY. DNOFCEMol IM NEWYORK Division Of Drvls1D on, ...in"d1IEs OVPPORiYNO1IY. wem pmnPrvnue Cemeteries 9 Alban NY 112hcom total a1R.a4UR AwyAgisaw Authorization for Cremation and Disposition This A,Oonaanon Form must AS completed and signed primer dtlWBrY of mMama/w cremation. Dow OQUIRMI ) Numew, 941 CremMq Name:Plm Vlm'Cr MmN m �a y�'Y Address:Quaker Road,Oueenall NY 128W phme: Op _It -1 CREMATION IS AN IRREVERSIBLE MD Fell PROCEafl Crearfu b carried out by placing the remains of tlw deceased and He wnbiner holding the remains Into a mmadon chamber"am May an aunlecmd M intense heat and Tama. The Mtl and arms will lnclnemb and comums G"Whing dare%Eons and MMI, which am all Seal will Me lea Seta/cremal r0110Wng cmmgon,the IXemamry,will take MsombW efforts to remove all of the remains and other making form the cremation Member,but some minimal dust and midge All likely oe left behind The cremec MN separatemddanNl and luelgn materiel from the remains and too Inddental and Small mOeXel as be 0gowd of as deduced law. The cremated remains At de methodlogy pumal Into small places and pladorem a designated comamer«um. Cmm d remains gansmny am puIRNrddd Merrill no single fragments mcognlrable as skalwl ueeue. OPENING OF THE CONTNNER The mmatwy manly open Me contravention m me un.co ed human remains In III drt urgenma such ea to conerm me menlllyofh de vedomWemumtMtnom knaraanrldaedwhlcnmiehnnlumamP,nyeaawdamaWa crn tOry PmpeM It human remains am dell ared Ina comalnerwmm Is not Suitable rorcmnauon such As commi or rents cal Na er or will require that the remains be moved Into a Modules conmnsr babe n accepts Me remains. Theopeningma ""imam.Ne tremkr er removal W munim All be conducted OeWm a mnW and will be done in privacy,with minill beamed. OENnFCAnaN OF DEC WED Name ofDmeama: Amy Cnds4rc wobard N,elml Sl s:D Lan Known Adored:14 OM Oil QU mWM.. NY 12804 Plea of Own 14 GregwW Clyde,QUNnAi NY 12804 Sax: Elm ©F Age:59 DQg:01/24/1953 OMe of D� 07j DPD Esmmamb Wdgm: 35MLy Qescrlimon of casketrmnmlrarIn welch remains All EB d W"d. Matthews CarbbOard Cremation Tray, WDod Bottom, Cardboard Tap PERSON IN CONTROL OF D sPOMON (Person(a)M mnhW d dryctilirn, (page ONF of Me M1Wowmg) m akin am the designated agent of the dec aedO Wa d In a all a mimn InMmW Agrute0 pursuant to Public Health has Samm 4201. y-OyRR mllg mA wee IWO have no kmwftwgo that me demaaed executed a Amain Ins met purgamto Pumm Health Law soedde 401 or directions for the Maldonado of his«Wm remains and IM are tree Mmon(a)having pnmay under Public Hearin saw, Sudden 4201 and have Me right to authorise demand,of Me remains ofthe dewased W#Our nlXl NrShlp to the dauasef A es follows'. AarY W m piexa�®ee MS-1996f(Rev.Mll Paget of Authorlution for Cramatlon and Disposition nn[en from the fist hero.)Numhx r) ONMpfwn: "\!NwR 1. A"mndnignot E,norritingpuwa,tWNNcMeWALaw3ecWn4901131: 3. me minded spouse, 9a no surviving domestic"door, S. My surviving WIM eighteen dean of we or older, 4. Aauwwrg mnof. S. A moving using eighteen years Walbal : 9. Alwalmly mounted guaNlan: 1. Any Porsants)eghteen Home W me of older Will to Who in Me Wage am VToioll cbaesl In refirsomen M Me demand: S. A duly appeared declare of Me aatmei 9. Achose teem n rNtlive who has executed a written stmemaM pursuant or PUNK Hnllh LA,Swon4$Ottl); 10. A chief Mall oxlttr 0 e cWrdy ar a pudic admini strator appointed pursuant be Me 9ummobe a Chun Meadfil M: IM, My other person who Is acting on behalf of We d emend and who has executed a wdllen statement pursuant to Pudk HealM Love Resume, bOH7y OpI9a ALL WFEE of Mlbwinpf IAVe hereby aMrm MNlhe Eddy ad the demesad does rim mmelna EeXery, naXery Oeck, power mil, redl0aclive lmplanl, or Attractive device and that any won materials were removed onorW the execution d Me AuMaroatlon Fain. Fellu e As Immune Moe Items PH"to coal my mutt In"in to the cromabry and cnmNory personnel. 4�NNe Winn Mal insWdmrs have Wean glWn to Mft K. Pensh M erww regaNin9 the removal a my Fie at pmOedy or either Ming reveal Mich any Porton among below or any family member dg deceased vNhn W proem. Film View Cremabnum isna responsible he Me removal of prs eonalm m M Xes from conminer or Me remains of Me deoeemd. Pomona Ibma left In Me container or wM Me romems will be daYroyal by Ma[mnwm proud u canna be mall after cremation. Me hereby aux rim Pine New Crematorium Precool to cremate the remains W Me d tined. (Initial OPTIONAL) IM nauby mall Me mmed fu l dirl to provide for delivery to and rnmi by an aXamp ry, If dwmW necessary In Ma opinion aMe funeral dlneor,and to emend Mis form to provide the contact name and address of such IHMM mmalory. FINAL OISPO3 N The"Won metal to race"Me cremate]remains of Me dxnand from Me ue is: Name, Carleton Funeral Hama. Inc. Address. 0 Main 9L Hudson Falls, NY 19839 Films.516747J243 The commerce mreire ofdsmesW sell be die"Eed roes falwn: x w,ny,..wn M..non mmW snow doe rat u99 prose.+imam.nram.tW rem.ma arm View Cremmodum Is auMx¢W to therep Onswersery Inamain res b Covered Funeral Home,line �I �3 pydeltyey In print or or by registered mall. A ors / I MvI (, ovl VZ DOS 18984 beer Ai Pa9e9a3 Authorization for Cremation and Disposition Bided fwwmwm ]riowe uManbN that f Me remainm ere rent lelmed wMm 120 data M=e Wn. %re view Oremamdum mry dN of the remains In Pv+✓ckremr animNavame mennm, coca adW son hng. CREMATION CONTAINEWURN fn a ONE ormemArmagl An um to he mag as mnWnds for Me oamebd remema has ease purchased ham and is consent as faeave VW&undenMnd Met it Me can is ka whi to Wit Me entire mamebd rvulu,an addNonel rem wruMv may be Mark!bdMMn -Des. An um a m1 y81 purcomed. Inve understand that n no um l4 Nor dm shatwu pmvmet PIm Ylmv Crematorium will place and Dammed mnairs In awni a real anniversarycontainerr or anniversaryMaki This AuN shadon Form win goWed by Me*K Pansh was OXWOW at CaM Font Homes Inc. 68 Man St Moment rose W 12838 ffuwexev�r and I signed ty uw serves director as window to its mandate. MAP have ttpeNed a complmad copy 0INn AUNMrgst Foren. TM penonfm Managed WIDv Wen iM person(s) In control ofdlepuhlon,who by signing this AUMOtl B on Famt, amw$h to the wo macy and ComPMnnsu o1 Ma Information contained I n this AWM1otlastlon Form and smhotlaNm the breg0100 Signed Mla Zdd` dsym S l ,2c 2 �14, f CIA Q J�.. . uy r4y weeks Aklai WITNESS: Mark K. Pansh rpaoemww�� ju`G-1 12822 Rank" wt Arri�W w DOS-18g8.f(Rdv.COpO) P%a 3 d 3