Donigian, Douglas Clifford Pine View Cemetery 8 Crematorium
Quaker Road
Queensbury: NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: gpT.
RETURN TIME:
DATE A TIME REMAINS ARRIVED AT CREMATORY:
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIOIHT DELIVERING REMAINS:
NAME: 1'o _L'AII1I SZQII CASE # SS�
TYPE OF CONTAINER:
PLACE OF DEATH:ESTIMATED WEIGHT OF REMAINS B CONTAINER- 1
^NILZ µn
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: �-:{�_ pp TIME STARTED: --Zt�— TIME COMPLETED, JL=�_�_
PLACED IN RETORT: 7-� __MOVED:
RETORT # 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 SxALL OR RETAINED IN rKE PERMANENT FILE OF THE cREMATOPY.
I
��11 o. OF CEM asr S
�} NEW VORK Division of OIVISIOII OF NEME16aE5
TA1F of e a
daily
P°" Cemeteries Kbl°�,,,,grm,
Publ ne.Pan Part
Authorization for Cremation and Disposition
This Auardz"" Form must tea complegd and signed Prior to deillby remains ter CremN .
Mte 07121/2020 Number 57f�
Cre MN NemB:PRI6 View Crerllarxinurn
Addrear 51 Quaker Road Quakee NY 12804 prole: (518) ]45 77
CREMPTKKI Ia W1 IRREVERSIBLE AND FINAL PROCESS.
CnmaliM is Grtl9d oN by plating the remains N tlN MC6eW eat Mecontainer bolding the remains into a Gemetior member wMrc
May art submitted b awards teal and flan. TM heat and flame will Incinerate and consume exry thing esimpt Mme add minimal,
which am all that will M led aMr cw flon.
Fdlwiiq cremaliw, the oemamrywIl take reasonable afoM to rempro all dime remains and doer maledal hWIMe common
NenCc, but dome minimal dust BM rescue will likely Ce kfl MhNd TM uentorywill sepeMe Inadmlel eat forego material hcm
1M reMm6 ar-01M inWemal.M mnewn m.ten.l what Ee ereposee a.srpuirM by law. TMoem&ed e,nswilbenmaniu
p "dw into small pas and resell a augMi60 Consumer or um. Cmnaltl cameos gemelyam puneflxd until no
alnarabannt Or recognizable as stNBMl t ue.
OPENING OF THE COIL NEN
The crematory may only open the member hil the untrrematee human remains In liinal circumstances. such as to confirm m ,
imandry of me comment or to ensure tat no material is tumbled!blee whim might injure employees a damage me Gemamry property f
human remains am dell"r m a container Mikh as net suitable for committed such as cerenewmeI or motel me,W.the
r tU wil l requ ire M m al tat consume be moats Into mm oa suitable conr bsfwe m termsit"order Me mine am. etermsnine of
wrMiurer or tat trinswr Or rem ldemaim Mli be committal lMwe a wlmess and all M done in larval with dignity end Nkm t.
IDENTIFICATION OF 011AAW O
Name OF I>rveaaed: QOuglas Clifford Dongian Mantel Btams: Divorced
Last Known addresses.6 Angel lerla. Ouftn ury, NY 12R04
Piece aoaaM Glens Falls Hospital, 100 Park Street. Glere Fells, NY 12W1
ask, ® M OF Aw: 65 OOB 11107/1954 Daledo 0712=020 Eapma vmgm:
Oes oat of usse Winer maTrJMrwna'ate willMtltelivered I
PERSON Its CONTROL OF OISPO&OON
(Psnsunls)mm d0.'sµ r p@N(ONE MIts rdkWgl
I secured are the designated argent of the hx.xe baseball in a MII or women bumvnent ueaMd puMOMto Pudic
health Lawscte ,4201.
OR
11L MehivenckmmWgematte Wroa ermneeawroeninhmempunuemm Pumm HeBMIswSM,on42"tora
win mrstal din OM for Va egpnaition a his or her remains and love ere me persons)whin Memory under Public Need Law
fNmdn azat .m nex me rgmro awtarde aremmmn ante rem.ma of the eacea.m. Myronr rel.Mnenlp M m.a.d....e N..
alwM.
Douglas Clifford ssed an
New Des-laWf(Re ,. 0) Pew 1 N a
Authoriration for Cremation and Disposition
(i«et bow the Ad Mi 1
Number: 3 Desi igeon: Child
1. Amason desgnetod In wherry PurwaMro Pudic Health lw$Mgn 1201(t);
9. The surviving spouse
38. The surviving domestic parman
3. Any surviving direct eighteen years of age or older.
4. ASwvrving parent
F. A surviving sibling eighteen years M Me or beer;
IT A last appointed guandrran;
T. Any Poacknou Minutes years W Me or all entered to ears in the estate and who eyes power in agatmNlp W tM dameSM;
I. Aduty aPordr Trial IN Me Waste
Q. A news Mend Of seems wed has executed a winen statement pursuant W Public Health Low Seam 4201(7);
10, A one fiscal ofimr of a muntyor a public administrator appointed pursuant W der Surnmea a Coud Prcmdum Art;
103. Any otM pesm Who lS acting an LeraH of tlrc command and who has endorsed a wagon sttl µhairs W Puppc Health
taw Season 4ml(T).
((nljgi I ALL THREE drN ldlonirp)
INh Mmby a nr that Me body of the dmamd dices rat within a Ntlery, coal pack, power all, ndmNss among.
m M'wdive device and Met my much mater4ls were removed pm W din exeoNon of the AUMoriaNm Form. Failure W rxroae
Makes MTe prior W cra netlon my mutt In berm Were cmrulpry and monetary parson«I.
J awe eMrm Mninebucliona have been alrenW Wendy M. Bulich
reOeMing Me removal d anyprsorel pmpeM w otlnr Mirq INvehm wNch arty person tlprny Cebx m arty bmlty memperolM
dpm«ed vol W press. Pine Make Crematorium
Is nM reaponeible ter Me removal d persorel items kom Me mMaimrw tram the whams cf the tivxaaed. Penmmf row IM In Me
wm.mmr mr wxn Ma r«wre win Md«fro«d by Ma mnmeMn prOceaa and canna M mdeved aror cmnana.
Ida
IAye hang auuodm Pine View Crematorium
rc.�.urrw.. to cnmfe nn nmire of the dewiest.
to"OPTIONAL)
IM hereby aNMriae Me named Nnenl dlmbr to provl«br delivery to and cremation by an aMnki
crematory, ndnted e the W necessary In M opinion of the m ral director, and to emend rho man to provide the correct name and
m
ms of such nhemme a rema W ry.
FINAL MSMWION
1M cemern authorized W receive the uemhted remains IXtlw diameter M1wn the crenkmoyr m:
rorrw:Regan Denny Stafford Funeral Home
Address 53 Quaker ROed, Dueensbury, NV 128M Phww: (518)7Q-1114
The mmYa remYna d aaaea'Nll be disposed al faces:
Realm t0 family
If for any moon Law pares named aK«a«rot tyke ptue W a a 1M aemabd ramabm.
Pine Vbw Crematorium is MhMdM1 W gw pmmetmd
$:wwl mum
the names to Regan Denny Stafford Funeal Home by"w ry
In person or by registers mau. vu..ra.nma Douglas Clifford Dongien
ww.wo..�m
DOS-rase-f(Rev. SITE) ppe3d0
Authorisation for Cremation and Disposition
merabway . . .
_�Ira aneersam mmnRro mm.teade na d.tmw vnmm tm a.ya aammban,
pine View Crematorium mq eacomame mmaima
an unmovable maanr.such as by emlamq. w.wo.mnr
gaEaaTICN mNlNNFINIRN
rndaRoweama/Mbnvnp)
_Mum to[e uses as a consumer for the amended remains has been WrWeea Fam
and a descdbee as Raiders
-
vweunmmundThat ame min acoo dead a hood The surms mad rerwne,an additional Vid container may be ume act dekvmy,
-0ah
ISO Mvn is mlyaryrUaeed. bNb urMenbM merHmum is pumAasNaolMMx goNtletl
Pine Yew Crematorium wut each me nmmaaa remains in
a had temporary weather for Wheary, w...woww�n
Tha sum arm Form nee prwaea by Wendy M. Bulich was eseoaea at
Regan Denny Stafford Funeral Home
graded..t
53 Quaker Road, Cueeneensbury. NV 12104
and in sip d by me antra airmr as wades to ie execution.
Me have received a comaeae copy antis determination Form.
The grsonlar disconnect below Wen the parson s)In conduct a dispwKon,and by di that Ai moararlon Farm,abmgei
to the accuracy and compaarwm 0 Ithe Information mnainel in this Iude aatlon Form and auMormais)ma Contracting.
Bisoea revs 21st a.ya July TO 2B�
Jennifer Donigian
82 W est Notre Dame SL Glens Fells NY 12Bg1-
wrtNFas: � -.�Wendy M. Si
r..euw.rw. err
f 0441
Douglas Cliffortl Donigian
WS1aa (am, W/!O) FNaii