Baker, Joyce Helen I
Pine View Cemetery & crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745.4476
FUNERAL HOME: __ p f _ _ _ _ RETURN TIME: A_ Sflf
DATE A TIME REMAINS ARRIVED AT CREMATORY:
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
NAME: —__ MVE ERFL'EP _�CASE9 firs
TYPE OF CONTAINER; �LLE�you 4-&j
PLACE OF DEATH:
ESTIMATED WEIGHT OF REMAINS S CONTAINER_
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION:
TIME STARTED: _ -�)•OS An TIME COMPLETED:
PLACED IN RETORT: �_Lyt�--__MOVIHE T'/ B
— > 4oartl f D
RETORT pIN WHICH REMAINS WERE CREMATED: _ S(.p(Q P fpil
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN OS HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SMALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
n Searsmpnenemor w
NEW PORK Division of DMSIONOFCEMETEME5
SJATFef e[emmone Pieza
Cemeteries wilmorinksorAveIrr,
Tww" Islat' �,6
Authorization for Cremation and Disposition
Thus Aulborlasuw Form must be COM~ and Sion plot to eeMery et mnulm ar cnnullm.
Dot¢-. [172112020 Number QS$
Crematory wme:PI M view Crematorium
Morass:510uaker Road Cueensbury NY 12804 pmre: 1518) ]46 77
CREMATION 18 AN IRREVERSIBLE AND FINAL PROCESS.
Cremation Is mined out by plural tlw remain of Me demasM and Me corvamer holl the remains Into a cremal chamber WRm
Mw are subjepM W Imenx lastand flame. TM MN end MmewNl MCInarNs vM wnsums weryWnp 9aeapl bon erM meNl,
which am all four will be IM aMr cr ton.
Follow N Cw m myn,Me uemakary will take rearsomi efforts to rem We all of Me remains and oMer mel¢nal from Me oemadon
chamber, out smre minims)dust and residue al likery[e kfl behind The consul vnll separate Inudenyl and foreign maleralM1wn
ryq remains and Me Inudental and foreign nadow MII b¢Mastercard of vs rwuiral by IFN. TM vemehd remain anti b0 m¢Granimlf/
putre!8d Into small piear and placed Into a d Qs tom wimr w III cm cur ins yamnlly am pulrerlwd Mail no
single rrmmem Is recognizable as skN ldeal
OPENING OF THE CONTAINER
The crematory may only also 1st Wnkin¢r holding the unaremated human remains In limited mmumtlanme, such es 10 oanfim Me
mentable or
tion, property
bemaan mmalnYm relleasdIa� onto na co Ymarwhkb is not uilabN forre that no model socialist why& 'ght ours,cmms uchyas ceremonial oremo lcaskab the
N
stationary will require Mal the remain be moved Into v rural container before Naweph the remains. The omnirq m e
mmeinerorthe Iranskrorremoval&m mawallbewndu bfineawMesaaq MIIbedmeInprivacy, vnMdpniryandmara l
OE FCAPON OF DECEASED
Name OF remember Joyce Helen Barker Medal status: Widowed
teat Known Myeas,]6 Buttermilk Fells Rd, Fort Ann, NY 12U7
film,a The , 76 Butro milk Falk Rd, Fort Mn, NY 128V
Us. OM ® F Ape: 87 DO : 071"1933 PabstO 0712112020 EmmYd Wak 4L
Deavigon W®ska1Vc1a`tlekaln nNdr nmaim MII Le tl4iren].
m br_y t:c �c o (_ C �r, ,1,
PERSON IN CONTROL OF OISP0811pN
(P /� s)in boi Wdsm ,, mmW ONE of fed(Gone)
hic I arrvWe are Me dugnated agent M to decreased desipnedd in atoll an r iruWrMM Memled pumaM to Pudic
H Mlaw SecWn 4201.
-OR-
III heroin MOMedge Mat iM Malawi executed v wmen retirement pursuant N Public tkaM Law SMbn 4201 «v
w it wRalmmp drctions or Me aep[anlm N his or her remains and live are Me bersmis)Mvtrg pnonly under Public HmM taw
Bomar CCI aM have Me OEM to ashorim venation of the rcmeins of the deceased. Myrour mia ship No M as
Uganda:
Joys Helen Barker
COS 1891H(Rev. 04W Pape 1 of 3
Authorization for Cremation and Disposition
(lobe/!FOm Ilre 49 6ebwf
Number; 10a p vcnpp0n: ficent
1. Adirect design" In wharq purauant to PWk Heats Lew 5 4201131:
3. The surviving spouts.
3a. Ta>urneng Mmestin parser,
]. Any surviving held ediment seen tape or older,
4. Aaurvir ng parent,
S. A sunning sibling wgtneen years of asp or olOer;
S. A nalully appointed guardian;
y. Pony parents)oghen years of pe or Oder writ"m sham in the estate eM whO Ware consent In rel"Wi toted Mwee4,
8. A Judy appointetl fimeni M Me more;
8. A dose Mend or Mapes who has MCCNM a wnnen statement current tO FUNIC WSIM Law SwtiM 4201 V):
10. A0of heal officer W a county in a public ad On18betor appointed WrsuaM M the Sumente a Coon RCtsduRAct,
10a. Arty other Ramon who is acting on lreNll of Me deceased end who has aeadM a wriden srtlement Wmuant In Public Hei
III Eastern 42e1O1
(M�FALL THREE IX my,Idbncri
.4b We M1ereby aMrm MM he eddy of Me d a9 dows nth mntain a badMy Mtbry,Over, power cell,radioactive Impint.
m r830aGve tlBNCe end Mal any wcM1 malerblawere renmwd pruru Me eucu4on OlMb AUMglntlan Fern. FWIun Mra S
Ma�y/a��lbma p for to cramelion may resin In marm to Ma cnmebry aid cranutory pnsonmi.
iJAS Mee thal'navugbm have bean green M WentlV�alldl
regaNlrq that mmmal of any PorawW prMeM Or Other Mlp of vasue which any person spring belw or sy Nmi r rof the
demaeed whine.to We ", Pine View Crematorium
Is rat rmponeibk IorIM removN W pwzonel IMm(rem 1M mribinaror M1om tlm mmehne W tM demesed. Perwntl Ibma M11In tlw
wnyN—AS—
ts n m wall deahryed ar or why ImalII by Me cmmatlon qxWid r a cannot My "w a rCRm .
\ S Irvx wmby sentiment Pine View Crematorum
tote $tlw mrueu Of awasad.
I�f OPTIONAL)
Vats hereby madminzs Me named funeral director W provlw br dWhery to aid Cro On by an abmsse
Mnnmy, If domed necessary in the opinion of idea Nneml director, and to amend Mle form to provide the come runts and
W dins M such ehomm crematory.
FINAL I SPOSRION
The person aNwm b Marva N90amaled remains W the tletsBeYJ Nam Me crematory 18.
Nam:Regan Denny Sbafbrd Funereal Home
Andress: 53 pucker Rwd. Dueenabury, NY 128M Pone: (518) 792-1114
The ttamh0 remains W d win Wdi al an fabxc
Burial— Brain Cemetery
nrn.m reaednMa patvu reined ewm aoeawllnnpwtseem W th.N.mm l.n.lm,
Pine View Cremarorlum Is auMniowl w gas pov men of
My MmhmIn Regan Denny Staffen] Funeral Home by del'rvary
M perwnnbv mplained mil. ,Ipyce Helen BaAer
nm.rwCsc
00 iao&f(R .. 041c20) Paps Rdl]
Authoringon for Cr atlon and Disposition
(�Ns ldbwNy
Iff; awe uneeeaha than Mare wheat are not rimed when 120 can d Memnron.
Pine View Crematorium nmedmmsse dthe eaebs In
an i oarseness never, such Me by anMnng.
CREMT CO TAMEMM
ONE rite la4mmp)
M um to be Load as a container Htle cremab]emsm has Mn pumlese l M1om
and is descried as shows
INIe undenlnd has it Me um a bay Mass bMd May snY6 Oamekd Rmtlne an addNMBI Iptl Combiner they Ee Wd WbNWy
SJIL Anumisnotidpwuhmsed she's uMe�s�eMNSMro umspuNeeM IXONemfw yoN.Md
Pine Vlew Crem barium :n plenne a.n.Md mama:,
a dad omponry omtinr for dnrvery, nw�eww+n
The Aurswtrasen saw ways provided by Wendy M. Bulich waseveadadn
Regan nanny Stafford Funeral Homo
53 Quaker Road, Dueanabury, NV 12W4
eM he signed 4 the Nrbral dl2nor as vMmu b Me eaeMun,
Me have m aruol a completed copy W Mla Asithw Uatlon FoRn
Time gnmisHtlen W balow mare Mys person(s)In condos W d6pasNon,way by N9 nine Ins AUMosaetlan Form,Ronda)
to the eacumy and complawass of the herma4on ConWrIM In Nis AUNodratlm Form aN�authorown Me breaoina.
91pmd MN 213t a JUIY .30 �.Nf nNMUIFU/NN Janie
StotldaN
1 5 Buttermilk Falls Rd., Fan Mn, NV 12UT-
Adnmm
mane
1Ylrsa-06: xe> t ^ n
Wendy M. Bulich
n 1MW1
Malawi
Joyce Helen Barker
sw.wosa
DOS-1898 t)Rev. O4Q0) Real