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Buchanan, Jacqueline K.
Pine View cemetery & Crematorium Quaker Road Queensbury, NY 12804 (518) 745-4477 or (518) 745-4478 FUNERAL HOME: ��/[: _ _ _ RETURN TIME: DATE B TIME REMAINS ARRIVED AT CREMATORY NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS: NAME: . ;RL-v=`-S.L-.r�.__._Y-1:LS,,11 CASE R _ BLZ TYPE OF CONTAINER: _ `aft PLACE OF DEATH: _ A^rRAE /�— F, Im-G - ESTIMATED WEIGHT OF REMAINS 6 CONTAINER_ (OE �4 PLACED IN HOLD: ,yy PLACED IN REFRIGERATION: ICbgp� DATE OF CREMATION: 7-AS7_ZOZD T TIME STARTED: � J— TIME COMPLETED: RY7 PLACED IN RETORT: a`� „ —T _ ---MOVED: RETORT N IN WHICH REMAINS WERE CREMATED: DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN AS HOURS FROM TIME OF ACCEPTED DELIVERY: NOTE: THE cpemgnoN LOG SHALL BE RETAINER :N THE PERMANENT FILE OF THE CREMATORY. prommilnlerm e _Jr,�wYORK Division of pnM°ol..."I hum gT. Fp. .e Rem NY Either Cemeteries Aftwer'x311,0001 lMM4M 226 Authorization for Cremation and Disposition This AWl "Uoo Farm must be compN d and W pored prior W delMry of remains forr mmetlon. Wto.07122QUO Number: 96t Crememry Name:Parry CremnMum ondmm oualmr Rom. Ole m,s NY 121304 Phone: lar CREMATION la AN IRREVERSIBLE AND FINAL PROCESS. Cremation is wmad out by p4cirg the remaky;M Me deaaend and Me Ideal Young the remains ones a MMm nchamber When may areabopcaea W Intense heat and flame. The heat and name will Incinerate and consume rve l,p saupt bons and metal, All are .n cot will be head Prior cremeao,. Following cmmetlad the memory will take reasonable eQore to remove all of the remains and other material ham the cremeWn chamber,but some minimal dual and residue well likely be left behind. The crematory will iepami ,wlldental and Wreign maker tram Me remams and roe Incdemal am Wrxgn material will be disposed of as required W law. The advanced remaWa an be Wechanix iry adwirmed into smell pieces ale posed rota a duignalm container or in . Cnmmd ramanns generally are puW rind coal As sharply aapment Is Wwgnluble as µsimi Blame. OPENING OF THE CO"TN"ER The crmaWry may only often the container holding the uncnmated human remains In fmitad circumstances such as boMflrm the Wenhty Ifthe dxsased w to ensure that no memdal is enclosed vi might insure employee,or damage Me crematory pmpany. If human rectal nor am G l lend In a cents lner which Is not a viaabha for metallon such ae caramonial one all chis kelp Are ,mmawry will require Nrtfha remains the moved Into a suitable mminder bbre X ari the remains. The opening rat conMimr or Me mother or removal of remains Net be conducted before a witness and WHI be mad in pdvecy.SAP di and respect. OFIInF CAT ON OF DECEASED Name M Dewaaad'.Joe lw K.[doument, MaM Sachs:Married Last Known Address:Sg Room Road,Oueenabloy,NY Repo Piece of Do=:gg RmMm Road.OuMn Nq NY UNIDO Sex, ©M ❑ F ANY 88 DOE:OW0131 Data o Death..mntrzom Emmotm Wxghb 100 D ssohpbon of avakeuwntairer In whxar remain$wail be dalmerm. Matthews Cardboard Cremation Trey, WOOD BoKorn, Cardboard Top PERSON FIN CONTROL OFDSPOSmoX fl enm(m in aanwl of aapwlmn BONE IF foe Weowwo I .mere are Ilse demanded seem mthe dewwsd meipnaWd in a evil or written instrument executed puiauam W Pul Health Lew Sxbm 42C1. O15,R v INY8 rave no kmwbda,Met Nor deaaead executed a ante,irsmumem Wnuant W ruled Heard Lew aeNm 4201 wa ,wining dif one far Me Manhattan e1 his or her remains and ewe am tiro renan(s)harp ptmty under Public Heam rude Sefton 4201 and have Me dint W summers dwmmn of the remalna of Me domW. Myrour relationship to the decreased is ax folb Jacqueline Buchanan DOS10aaf)Raw.041 1) Page 1013 Authorization for Crematlon and Disposition fire fmm Ne6Nmmnq I1� Numlw: 2 Description: twfagerr] 1. Apnson aeslpri writing pursuant IS Public Health trar Section 4WI(3); 3. TTa¢urvirng aNa xa The eurvwmg acmealk partneri n My sal true alehtmn nro of age or dC a. A suMving parent) 5. A¢mlving Sibling emprom rater of age IX alder: 6. Abwlully appointed guar gain ). Any parson(sl eighteen yeam of age or alder enulha to aI in Me wbte age will ia Ce Ost In relerjal to the deRssaa; 6. A duty appointed currency d led note. R. Apow Mend or ral and has erewbd a written Nlem tmmumt b Public Health Law deal 4201(7tl 16. A MW fill otrur of a county or a public admtn, h fag OM punWm to the 5ummany a down Procedure AM tea. My dra"mon who in Acting on behar of Ne deceased and wed has mwMed a wiaM annmant pursuant b Public Health Law Section 4201M n eEreby rmthat hereby amlm that Me may of the deuaaea en¢ cad wmin a betters.MMry perk evwmaen,naroAmNe mgam, or adlOaNw aevim and that any gum memaala were remcvea prim to Me epMf d MIS Aulhw atl FOM. FAunn mlove Mesa Items prior b enmeeen mry mu it In Mrm to the enmbry and Mmabry pen mW- IAlaffirmthatnNnwWmhavebasegNento mK.Parish rube 1 regarding Me innocent of any pmw pm[ Morinner hung of valuer wMM am person aligning WIOfsly fmrdv member Of Me tlemased moms bpmerve. Pine Vale,Cmmebhum n cam respw¢Idabrtlu removal of panorel Items from the conbinerorfmm Me mmbee mind dewmd Pomomi lbma led In Xn with the remains will M dnveyM by do mmauon pmn¢e and cannot be nMeved beer cnmatlon. )Aye barony sMnania Pee New CRmebnum b mmte Ne nmJm M the deweM. PnoNAy rn11 rise he,Nry amholve Me named funem aMqu,to provide for all to and mamtllon by an mennaa Mae"—.hummed no�nmtlorya opinion onnawmnldirector, and to amm MIa form to provlaa Na Partname and aiM FINAL DI5P0 SMN The person N to recdve Me vem&M emans Of Ne ten ham Me mmtay re Name:Gran Funeral Home. im. posped:65111 Huwn Field,NY 12839 Phone 51&I04303 The mma n ire of decaasW wN be dbpa¢M Here kM0M: (wJ Il b any rased Me named agents does M Mae pGSnaMn of Ne Cremated MMAMs, Plmv'wwcm Mlun 1¢euVMxM b give poamvonof W Me nmaNa ro C°a°bn Funectl XManuel.Yr.. by delivery in or by ml mYL J MdheBucNnan Pmaw DO&1696A(Rev. 041]0) Page 2 of3 Authorization for Cremation and Disposition ning) undy di NM J the remains are not demM when 130 mend 0dramounn, view cRmatdmmm miss aNmae mine remains In Mw n amrrelnevade manneC men as by ecalleMq. CREIMTION CONFAINERIORN I(aia ONE and,imma gf An can to be used as a mntaimry Me usmM1tl nm4na has been purchased hem and I¢demanded as rabn: Me understand Pet Xthe um N am smM M hold Me mtin command remain,an addiavnal read container may be used for Money. OR -gQ—ln um is not yet purchased. Me understand Met if no,on in northwest or otherwise pmvlaM ,iota view CremmMum arl plea Me camated cement;In a mole tmnpatery¢mtalmrMdellvery tracawrovt This AuPwlmi Form cone pmaded by MeM R Pea was widowed a puiwsimeavrvmn fadaton Funeral Home. Inc nn.n'rwww 88 Main Sy, Hudson,Felt.Felt.NY 13 ammervie areas served by a forward Indoor as wilre80 to he common. m Noe was RmivM a Merchant body o1 this AuM Ml nForm. The panor lowered below team the mm inj In wnool of deposition,who by signing this determination Form,attaspst to the emmmy and compleAnnw oe had Information cents and In M Ie A Uncommon Form and Su Od s)the bregoing. Mormid Ned day Julyy ,gap John Buchanan X Award ve lwart, S: r Me* K.PanM rpnnenm wma IXv 12072 award Jequame BuWnan wwwmwww MS I NS4(Rev.oio2o) Page 3 of