Johnson, Linda Marie Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NV 12804
(518) 7445-4477 or (518) 745-4476
FUNERAL HOME: _ LFk. / RETURN TIME; 7-13-1 W
DATE R TIME REMAINS ARRIVED AT CREMATORY: T12'70Zd // ZSAN:
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
TYPE OF CONTAINER:
PLACE OF DEATH: _` /JZ
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER //TO ok5 9^J
PLACED IN HOLD:
PLACED IN REFRIGERATION: _
DATE OF CREMATION:
TIME STARTED: TIME COMPLETED:
PLACED IN RETORT! _ -IA MOVED: _
RETORT A IN WHICH REMAINS WERE CREMATED: -
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY;
NOTE: MR CREMATION LOG SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
NITY. eknE Op•mn wsu
�IVISIOR Of OSION OF<EMETERIESWGIYORK
OPPoRVCeme`efles
T•ep Mw gistak 6
Authorization for Cremation and Disposition
The Autl zaaon Form must be completed and signed prmrm delivery Of remain for manager.
Date'. 071212020 Nundar: 955
crematory Name. Pine VB Cremators
Address: 21 Quaker Rd., Oueensbun NY 128M phond SIR9949494
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Ctt On is wm ad by facing Me remains toted aw and Me iMrhddirp the remains into a cmmOon tllemMr em
tM amsublecl OiM neBlwatendaama no hog and name will lnelnaa add consume evaMmng except bone and men,
whim an aN Mat Mn W Im aner cremation.
Folmwinto tin n,thecrematory will mi reaemaae e%ens W remove all Of the remains and Other hateful from Me cremation
chamber but Some minimal dust antl xdue will likely be tell owned. The crematory mil separet6all and foreign radial form
fine mrs ire and tlx uckpmal and foreign material will predisposed Mss rryuired by law. The cremated remains art l be nowmanireay
townsmen I=small dome and placed into a designated consumer"um. CramaWmmaimpanmuyampuwde uninr
mrpm Moderate s recognizable as geiNtl mwue.
OPENING OF THE CONTAINER
The comatory may only open me WA 10er facing Me umc MBd human rename In limited ciumstarces, aunt ss to anfirm the
idendty of the dew Or WBnwre Mat no materlald adopted which might injure employees of damage tie cremebry pro , If
human mnalm am delivered In a mnutner which is not sugle far cnmadon such ate familiar or fennel ebb Me
maWry will require Mat the remains be moved Into a rubble contain r bNrre it accepts Now remains. Tne opening Ma
container or the transfer or removal M remains will be conduched before a witness and Ad be chosen novel with dignity and respect
IDENTIFICATION OF DECEASED
namediferomee'. Lintla Marie Johnson Name status: Divorbod
Led Hnown Address: 22 Hilltop Court. Warrensburg, NY 12885
mace of Death Deceasaft Residents, 22 Hilltop Court, Warreriourg, NY 12885
Sea: O M ® F Age'. 72 DOB: 11AD311947 Din of DmM: 07/212020 ESdmatM Wail 110
Descmdon INeeskeVWnmIrM In l remains will be daY,rd".
Neal England Cremationdeluxe cer4ainer
PP N IN CONTROL OF DMMTION
(pe (S)in6 of disPosdmq inliiel ONE of rM/d10w4gf
I will eR Me musgnated agent W Me deceased designated In a will or when instrument exodWM Pursuant bo Public
HesHn Law SMWn 4201.
0
IMIe nave no Mx wl¢tlge that the Microsoft executed a Must Instrument puuard W Public morn Law Not 4201 or a
lalninq tlirections fin the domosllim of his or her remains and IMP are the Mmn(s)having moray under Publk Health Law
usudon 0201 and have the ngMW at odZ pema40n of the remains of redeuea60. MyMurrelationshipto Medeceased Mae
Mien'
Linda Marie Johnson
DOS-IBSO-f(Ree. Wl20) Pape l of
Authorization for Cremation and Disposition
(mews fmm the far mrowJ
Number'. 3 Description1. Sulvmina S
2. TMmondngwMdlnwmWpunuanlb Publk HeSM Lax Se n4201(3):
a ¢Fora
le. ltu summing Saud kpamper,
3. Arry swnma child elgtt«n years of age or older',
a. Awrviwng parent:
S. A suMving Sibling eighteen years of See or older:
o. A hwNllvappoiMeo guaraieo:
T. Any persenlq eielMen rears of aw or older Shouted 0share In to estate 9M who 'Were GOaeet in oratennip to the aecasm:
duly appointed
2. A dose Tend or reafive whotM1semtebutted a whiten shemem
10. A Mm fiscal officer W a =only or a public edmintstratm a Purism ou maorreM Heats Lax Cost pl201(une we.
TI',
Mae. My other ceRM who is strong on behalf of the borrowed antl'wM has execWd a written$l mem pu%am W Public Heauh
Lax Sem'm 4201(7).
GALL MREE of the blowing)
lNe memory,agent Nat the body of Me d Cea$ed does no WMain a battery. Mery pxk, power cell, redlowmas tmpbM.
r di tlly¢¢tbvlce and that any such materials were removed morlc Me execution Of N¢AmMor "W Form. Faltumwn ove
these Items poor ro cmmabOO may roue In ham to the aerosol and cmmbry pn mi.
INi¢ Mum that lnshuggna have teem Bruhn l0 David"
dVla�d"I'ma,de!
ea rg the removal of any personal Wro or otheruma mvalue which any assume etonirg bmox or any lamas memberWme
aexaud washes top the. Pine View Complaint
is not minorities,b sp
read omi imma ham the comalner pthe remains of the deoeae Personal led$ lee In the
tanner orwnh Me remelna will be deab bytha cremmlm promms and cannot tea romavaa 2"rcm moon.
Me hereby aut came Pine View Crematory
Kw.mM to cmmuh Me remains of the dweaY h
(areas OPTIWIAL)
tNn hurt authmke the named funeral d rector W became,for delivery to and committee,by an alternate
cemen WsuchaltaternalmI in the opinion of Me funeral direcbq and W amend thm form to provide the correct name add
addresFINAL DISH mON
The peach authona¢d W hicame Me mmetea RmsNe of the de2usd man the pent is
Name.Alexander-Baker Funeral Home, David Alexander
Addreva: 3808 Main Street tNanensburgr NV 12B85 phase: (518) 623.2065
lee amounted rentals Of d¢re will M imposed a as scheme
aotumtofamily
If bar any Raapr the pars= national$ a does not lake passion of pie bedroom remains.
Pine View Crematory is aup wto are paes wan of
the remain$to Alexander-Baker Funeral Home WaNirery
In pawn or by me3m may. Linda Marie Johnson
n
DOS-18a8i(Rev. OVM) Page of
Authorization for Cremation and Disposition
"'I Vosereei
Me undarstaMtNt if Me remains are nee chimed whin 120 Wya dainnest
Pine Vieer rematory may diepam acne remwmin
an inN'gvable manner,sucn as thy scallenng. c�+w�n
[REMOTION CO `XTNXF
f�ONEadn MWnbigl
RJURN
An um to W used es a whiner tm this nemeled remaim has been purchased trcm Asmander-Baker Funeral
w.
and is MmM ad as folows.
IWe understand that it Ire um is tw anal Is had the ani cremabd nmaim, an addRmal raid wMainer may In used rm ativery.
-OR-
�/JL AnumismtyetpuMased. IM1Neundemi2WtWencum4qutltaMoroIM proAdM
O\ 1) Pine VlawC at WII plan it ethernet meant;in
a him 4mpp2ry whiner far ddimry, rvrn.ermwm
ThisAWMN mFormwaeproudedby David aezanticy was exeWed at
Alexander-Baker Funeral Harris
W09 Main Street, Wanenaburg, W 128M
and is agree by the areas J,ai as whines to he exeation w
lMe have renelved a wmplete] aqy of this Amendment Form
The pemana)Identified IMIM Whare the pemonts) in control or disposition,wno by giant" this AUMorisamia Farm,aXeatis)
to lee accuracy and wmpMteness of the iMormNion contained In this AUMo///nzz''',almat Formand euwne ln0�
tlns)the Rea
alanw tea 21st day July , 2
AmY Mom. Johnson
13 Knight St., Glens Falls, NV 12801
Ali
same
WfTXF3S:
David Alexander
�an.esnwa..w..l
10034
Linde Mane Johnson
DOS-10M-f(Rev.M(30) Pape 3013