Bureau, Jeannine C. Pine View Cemetery & Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (518) 745.4476
FUNERAL HOME: _ d9t f/ RETURN TIME: 1-237LT20
DATE S TIME REMAINS ARRIVED AT CREMATORY: ?_s2 _ dTO //3dON,
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
NAME: 38GD/I%ML 61 31,L/fdfA I CASEA OT
TYPE OF CONTAINER: NCI ..,,! GR.:Oc.L. dI 102 l lid
PLACE OF DEATH: l�J' de{ 14 >Zas /c:..c 5J�@�1A/A.f7eA./t ZRN N ,t11/ 119S
ESTIMATED WEIGHT OF REMAINS 6 CONTAINER IlOAvS
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: �IL�I'LO
TIME STARTED: �I:b TIME COMPLETED: pM
PLACED IN RETORT: 7, qE MOVED: �.S'/A /y(.i.11 91UAn I V
RETORT A IN WHICH REMAINS WERE CREMATED: �.wi :•r�u_ SLFtgps4 rna
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 THE CREMATORY.
TEW PORK Division of BIVISION t1F rvEMETERIE3
oTwoz�ilxm. ew s°ct nA enue
Cemeteries ham
Tom,.. SINrn6226
Authorization for Cremation and Disposition
This Autlror "m Form must be umpla and snai prior To pewary M mm�nelu for cnmetien.
Dole: 091212020 Number:
Crematory wave Pine YMw Crematory
Addred,e: 21 Quaker Rd. Quiesensli NY 128N Rom:T 1B' 7YS-NN72
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremabm is umea out by placing Me remains 0 Me tleuau0 and the conuimr holding the Me 1Mo a cnmaood cM Wien
they am subjected W intense neat and name. This hi and nsms willIminerah add mnsuma WBryting a Wt bon eM mMl.
Which ere all will the M after cremation.
issuance marcher.We crematory Wall take rmwn ibe elbm to remove all of Me remains end offer mating horn Me mmarm
chamber hN some minimal dust and residue Wll likely be led behind The uemetory will sepNM cookie and laeien magical from
the remains and the nadmnl and foreign maWrni Wu W d'acNd of as governor by law. The chemi remand,cell be merchandise iliy
puroenzedink amen pieces and plawdimo a respecter nonlinear or unt Cmm rwnanseennalyerepubm unalm
single fragment w recognizable as AaMal Masud
OPENING OF THE CONMINER
The comment may only open Pe container trading the uncremalM human remains in limited prcumstanus, such ask WnNm the
monody M the wMN donsw reheat no households emdreed might lnryre employees or damage the mandatory,prcperm, N
human remain are delivered In a managed nor whkh is not sulbbla for deposit slash as uremonial w normal"sMk Me
conmmark will ry scheme qulre that Me bs highest! Into Xa In a subleconninw W m tt¢capre Me remains. Theopeningow
tainer ortne trawfirurremmal W hamaimwiuM undreW clan a Witness and Will be done in priary wit dig"oMreapaG,
IDENTIFICATION OF DECEASED
Name of Dettned: Jeannine C. euRau Mehl Shrugs: waowed
lain xnpwn Aedreee: 5038 State Route 28N Newcomb NY IZQ S Z
plaudO : DeceasB 's Residence 5038State Route28N Newcomy, NY /29SZ
Sir. 0M OF Age: 90 DOE: 10/1811929 DMdDesM: 071192020 EMw Mdwl 120
DuclpWn dwwWrmmaimr m wwm remwmwiu go delia.M.
New England Cremation deluxe container
PERSON IN CONTROL OF DISPOSr11ON
(Persm(sl an untol ddspe ,, ias PYE of IM Rossini q)
emM1Ne are that de6igmted a gent race d Nagasaki a WII or wagon instrument etW damaged k Public
He th law Seem 4201.
oN-
K`i IAft Was no MOWedge that the seuaud encored a vabkn instrument puguamk Pubic Heeun I.aw Section 4201 or
Wn unmirnne directions for Me dlNwd,mon of his w her remains add lead are Me pemn(s)been plwhy,under Public HUNn Law
S on4201 am have Me rghtto authorize uemage of the remains dthed au d. Myrour Mlaaomhtpto Medausssdbw
blew
Jeannine C. Bureau
DOS-18961(Raw. 041 Pape l d3
Authoriution for Cremation and Disposition
pnaan M1om the ilk relow)
number 3 Descngbn:Surviving Child
1. A parson designated 'in writing funeral to Public Heats lax Section 42o113):
2a. TIR aYm pMoral paMR
a Any surmina child eighteen yams W She or older.
A Asuch irq parent
S. A SYreere ybling big Mean years of age or Oder,
0. A mayor fir appointed guardian',
]. My assumed by clean years of age or older offset to share In Me create and who Were amend in r wship Nth demised',
S. Aduty asserted fiducary of the email
g. A chase Nmd or relative who hay executed a weNen statement purnal to Pudic Health Law Section 0201p1;
10. A chief firnal Creole N a county or a WdlC essential apporem Wrumnl to the Sumerians Court social Act
10e. Arry other person who is acting on Named Me assumed and who has executed a when stl M purwenl to Pudic H"M
law amnion e201n)
G� nALL ttIREE arms InWrwna)
RCR IM1Ye M1ereby affirm Ma11M bMy Mlhe tlBtteeetl tlCes n01 Wnlainadylbry, bObry INd, power Cell, rafrommeimplant
or assassins device and Man any Such materials were removM prior m the exmu0on of has AuUxmzmm Form. Fall to remora
Mum Name pdm he cranwtlon may MUa In harm to tat commodity and amend" perhourall.
RQK bWe affairs that instructions have been¢ier to David Ameaander
Mamma they ranoval neny peewnal gModAAy or other Ming ofvalue which any pawn ageing below or any family memder of ate
deabesad wishes to reserve. Pine Yew Crematory
is not responsible for the removal of perwnal hems from Mr wnWner or hay toremains of the Manuel Mnarral iruu Its in Ma
container or with Me remained wall br destroyed by Me cmeWm preens and abroad be rah WH rcremation.
RIP, vxaherebyiumromm Pine Drew Crematory
v by cement Me mnalna of Me deCeasatl.
I(J CPTIONAL)
Its hereby supreme the named funeral director pmvlde for delivery N and cremation by an aMma
rmina , R deemed necessary In the opinion of the funeral deal and to amend Mis form w advice the Martate name and
Mdr at such alternate Cm tGo .
FINAL DRPOSFIOH
The Avenue Authorized to moves that aemdad someone of the tleabared from tat aamakry is'.
Name'Alexander-Baker Funeral Home, David Alexander
Mariana: 38M Main Sheet, Warrensburg, NY 128M Prime: (518) U2 2085
Thad cremated assume Cl tlxeased ad Mdbmud of as followed
Burial in St. Therese Cemetery
If Ma Mermaids Me damn named above does not ham msnwbn of has wmabi remffin.
Pine View Crematory is suMOede0 to give scandal 0
ro+* ","',
the renamate Alexander-Baker Funeral Home by heavy
bw w w
in perwn an by registered man. Jeannine G Bureau
S 1Sg6f(Rev. drzM v+
1 of 2of3
Authorization for Cremation and Disposition
l�nnrpaaMp)
RCP, lM urpeNmM ffth mmaiosarenNdaimMx nl2odgsofcramedon,
Pine View Crematory maydeposo Merainaimin
an imandwela manner, Such as ey svnenrg. er a
S'aEMATNIN LOWA NERVURN
(LnEIa MEoflM rIXbvmg)
RAlexander-Baker FuneralOCRnn amroee Saes ass mnlynarmrnre cremarea nm.ina nae Been pnchased Lam W....._
and is deecdeed asmllowe: MacKenzie umNautt-Emerald
INS understand they EMe an is W Small to hop the entlre pemYW remWa,an aYIWM held wnbLp may W wq W deMery.
pp
�_M um ie ru[yatpx ligeed. IM'e untlermeM Ihatilm um N puchurJ aatlwmive prbridNl
Pine View Crematory ell paw the canned ranaim In
a NH bnponrywMtlner for dglvary. mr.✓c.mn
This AUMadeatlon Form ws pm%kcad by David Alexander was asealMp
Alexander-Baker Funeral Home
3809 Main Street, Warrensburg, NY 12885
and is agreed by the funeral Senator as wads W he sddism �r
INS haw received a compelN ropy of gas AUMorleatlan Form.
The parsons)Wendfled bide Wan the persons) In comma of dNpoaldon,"a by Sig nlna this AUNmrhallon form,aXaryq
W Me accuracy and oompMeness of tln lnformedon wMeloed In Me AUMoreetlnn Fwm what auMorlaafa)Me arpWrq.
Shined this 21 at dayal July ,20 200 qq
Rena C. R=o zi (2 iglao
rW
"I Lily Lake Road, Highland, NY 12US
Zni
rwue•nw... ew•
WITNESS:
David Alexander
iaou
Jeannine C. Bureau
dredsr
DD.N IBa&gRev.042M Ppe 3d3