Vitarelle, Arnold R. Pine View Cemetery 8 Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745.4476
FUNERAL HOME: /R51T,01/�{ _ RETURN TIME:
DATE B TIME REMAINS ARRIVED AT CREMATORY: IIZLI TO Q'lE(R1
NAME OF FUNERAL DIRECTOR OR REORISTERED RESIDENT DELIVERING REMAINS:
Re"op NoA_$_
NAME: ,,__ _ AEWLO O'IJC//UA/UL p _CASE0 SV6
TYPE OF CONTAINER: /e E'II Pei{ Ik fmc 6,Sf
PLACE OF DEATH: _ VSIA t�
ESTIMATED WEIGHT OF REMAINS S CONTAINER IlL Il�
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: 7- 2 Z -Wzo pp
TIME STARTED: io 3"i TIME COMPLETED:PLACED IN RETORT: io3S4Y _MOVED: y� ' �I QJ rywn11
RETORT 4 IN WHICH REMAINS WERE CREMATED: 1'IE/P K / nl;l)�+
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS VI„FROM TIME OF ACCEPTED DELIVERY; 9
NOTE:THE CREMATION LOU SHALL P BE IN THE PERMANENT RLE OF THE CREMATORY.
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Authorization for Cremation and Disposition
This ANh on Form must EecomplW weakened art radial er 21/m far wmauen.
Oak: (PollNumber 149
Clema Name: PneY Chimer
Address: 21 Quaker Rand Qkw m Ray NY 126M Phone. (518) 745M77
CRENATWN IS AN IRREVERSIBLE AND FINAL PROCESS
Cremation is business out by poll NB smairm o1 MB aBMaeM and They wnmimr NOWing me manganese B GemeYan Wmma Whom
they ate mmented to rise head and game. The 11m1 area Mme will lnclmmb And wnwms managing mwpt Race and meml,
whim are all that Will be IM after cremsaon.
Following uemauon.the romancer r 11 take reawrlaak afford to Law" a1Ve angry and nth«mammal hwn NB thermal
chain am but come minimal d ust and realam MawIikeNRa ten bel The are =7 all wwlak goal and fral mal haw
the remains and mescal and rortign material Maw ae diseases oars rpwrtl by lax. TM serrated Rmainarrn Ra medmdaalN
puhrenees Thin smell pines ant pared Imo a desiinamtl mntanera um. Cremated remains generally an pulwr d Lag Ads
single amgmomla meagnlaable as skekml0ssue.
OPENING OF THE CONTAINER
crematoryThe may only wen the mainer adding be un<remated human ranains In limited drwmsmnrea,such co as to confirm the
identity w uuhe aoduases arm mane that no mall marginal vrhim made make schoo eBe«damage He semmory PropeM_ N
human remains am anwr¢a Ina container whim Is nor suitable far warmhon such as cwemonlal or mall casket eve
Ranawthery will require Mat b remains be moved lMo a suitable denim.emote Race"Me remains. The oeanmg nsa
cher Or May banner Or removal of remain Ball RawMuded All a wN4ss and All Radom in puma/,with conlN and reaped.
IDENTIFICATION OF DECEABEO
Name of Oeceesea: Amil R Nmrelk Mantel Slates: tarried
Lag Known PGareu: 4800 Rwm 80 Grnx MNY 12831
Pmreolp flaw Romer 80 Ga MNY 12MI
For pN OF pre. 93 DOg. 05/25/7927 DakofO : D711742020 FalanakaM l 172
maaipnonmaakNwnlNna n which remains vat ber""l ,
Cardboard! Box wlWoolen Base
PERSON IN CONTROL OF DISPOSITION
(NMW$)mM Mdlspa ,, nL ONENMe/dWr'mpJ
I armil arc flaw designated again M MedMeeN deralgnmedm a all or B nInmumnt emalel pa¢amt A Public
Health Lee Sewon 4201.
oR-
lMbnaveneknwhadmiMTHedemamlam swum, instrument p maker to Pasa'e IWBIm Law suburban 4201 or
sell mrtalrvrO dr s Far they d,SY w of his or her remains am IM are Me remon(s) having prom,,mor rural Health Law
Sh0.yr42% aMhrw Me NhltoauMa¢esemaflwrof Memneiaof Medeceased. Nylourmlaonshlpbusa ssdmas
bllcwm.
Arnold R. Vitarelle
Wheal
C ERRILL gil DMM) Ppe1ol3
Authorimtion for Cremation and Disposition
lmameramnyme as beroq y^i-r��� �Jy
Num[er. -✓ Ora om: �f—
1. Pe nuatlee interpreted In wr2ng PunuBmbPUGlb XetlN Lax SeGkn Q%(J) � I Rr � ��
6. The sureil dove¢: l
]a. Any annoying eommlmeen ways
Anrawa preim e9Mee^neap of.gem Old.,
/ S. AsurvMrgceren(
S. AIde survival elgMeen yeaB Mega or door
S. A yperlyitingsswer n wide
L And PonP^laleigmino yean of he"e orolberenNb4la snare in the,estate and who iOan Gweal In reletiomnipb Me OeveseE:
S. A dulyePpniMW minor Mee who has Manna
9. A tlommandmnr of
crioenpMBdllusua aldepospurtuaMlo Public Health Summary
5eeurt Ohatlji,
ct
rich.
My
ss wormen who
a wetly or a public all
my decrease
and
dwho samhas exelbnt Sunrystat Ceurtnt pum"t Public
aW. My Swell pmm�wM10 188C4rg on CfYIeIIMbe Eesa¢ed albwM1a M1ee axevbdawrlMn alaRmeMpurslwnlb Public NeeM
Lax SealendIDATI.
MxI( ,�I I�1ILL THREE m me hRmnnpf
li hereby affirm her tlN body of be desase]deals rwl summer a beMry bodmy pace peer mu, rWioa dw¢heath,
ornmanure dev'm eM Mat any slM mebreM were removed Wort the execution many AM &atl Form. Fellumbremove
mary Nan pdab erametlon may noun In harm bMe Miami and Manuel p mmonmi.
IVIn'.,yll—INb emrm Mal lnlsbua4me here been given RoIIarl Hoag
regeNirg Mn bell of any Personal past eny or other mine Nvalw which any person signing brew or any bmdy member me they
W¢md wshi to preserve. pith VI"Lremebry
s ml rearormlbk br Ue remwel olcelsmal Ibme kwn MB[muirererhom Ne remand Mete d�a¢ed. Pemaral lbme bh In Me
then crash the remamexill be desbryad by Me meta on prom.e and eannNM mummed aRnrenmauon
Me hem"auMndu Per vlrw Cremebry
mMer io chimab the remains of the demawd.
(armed OPTIONAL)
Vvn hereby summers me named Nwpl director provide for delivery b and moral by an tlbmad
Mabry,if Miami necessary In Me opinion of the foetal director and by amend mb form to provdee me cerrett name and
address of such abmea Manuel
FINPL DISPOSITION
TMcerson Mmiaed b member Ce aemetM remalm IXMe dare men m ,w Mq s:
Name: Commercial Furenl Care
AWPoH Apg Maple An. fWalogs SglryA NY 12M proma. (518)tha is
Tre Memel emaiM M deWa Mn be dg OIO fences
-a facy
If for may nsscn Me pension named abuse dm net Map presence of me mmilz wets a,
pmr Wex h. =m y Nlfmm]b guru Malaysian of
�v Ml
memnamb CdnMasionele FumBlCro. lz Nybllrery
in[ n m by"assume mail. in��xaw AmN]R. YIbMK
COSTS%f(Rev. (emsd dean Poe 2 of
Authorization for Cremation and Disposition
m whet
WN N0a9bM Man if Vq mundane am not tlaimeo xtNm 130 dap Ot[rametlon,
PIreY Cremamry "dlsp-aeofWm amain
an lneMavaeb manner,such as by sadial a pn
CREMATION CONTNHEAUUM
QeMiI ONE coma general
An Jim m the used as v mMarcr der Me uemtlM manage has been pw am from
am Is Wam2ed as mlbws'.
At mode M that tltice um Y mo mull m hold Me whoa dal mNine.an Wdi at nil summermaY day may!mr dMiwry.
Pnummnotyetpurchasad INh understand that II mum is puMl"mnd Wue pru'ided
Pine New Comedy yet pyn Ne vemeetl fight in
a rigid deal candfnerbr detlrory.
Thu AUNor on Form was prodded My RWsq O. Norg weaenmaJM
Componential Funded Cam, Inc
aM Meplehu2.. Cara19a Sgiys, NY 12M
am m eignM by to Nnem o l director as annu To Myawa S hu mn •�N
may,have rariyed a thmbeted tap/of may AWbm nt Form.
The perform)ltlentlMd talon Jimmy me prvanmJ In deal of distressful aMo al nmp this AUNoriaati Fomh act gs)
by me used prady and mom plWn ad Me mutua on cOnminsd In mAof vuNoruNv)Me mosel re.
9pnad this 21st ay, July 2 20
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WITNESS: /
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Amato R.VpYBA¢
O08-1119884(me,. O4R01 Pa/3olJ