Delaney, Adam Lee Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-44,F7117 or (518) 745.4476
M
FUNERAL HOE: _ gAr/FO�. RETURN TIME:
DATE & TIME REMAINS ARRIVED AT CREMATORY: 71n lie 2'YDm
NAME OF FUNERAL DIRECTOR�OR REGRISTEREO RESIDENT DELIVERING REMAINS:
—__ PLWEY 0CltRb
NAME, L}ONN PuAIJE^y /I ^ I CASE P 898
TYPE OF CDNTAINER; _ /}_ y1CIFY aelly 4� DU J}y L /d D Sag
PLACE OF DEATMIIAE � '�
ESTIMATED WEIGHT OF REMAINS & CONTAINNEER Lroo 16
PLACED IN HOLD:
PLACED IN REFRIGERATION: 7,jo
DATE OF CREMATION: -/�.L02A yy
TIME STARTED: �; y TIME COMPLETED: IO"1
PLACED IN RETORT: 736� MOVED:
RETORT Y IN WHICH REMAINS WERE CREMATED: S ¢n p MS
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN AS HOURS
FROM TIME OF ACCEPTED DCLIVERY:
NOTE:THE CREMATION LOG SHALL BE RETAIN[O IN THE PERMANENT FILE OF THE CREMATORY.
Au.. wizutlonjoz pemation and DispDSidon arso.,.nn«.aan.
wee
sefew
zmaawmev.Ean IsomIlwnee aPNwfanawa++sneJwiwro d*Nw azerxaW roeennlaum. mn
Dait '1/0fu Libel 4A
cre++atory Name neVimC m.
Atltlrxa aueher RAwl, Oueerwbury, New Yore 12dUe Plbom: 518174S u
CIIEM111WN Is AN IN E1 11 IWP FINAL PROLES{.
Cwmcnon is mrtlea out by W Utrathe remmne ham,e¢ewo and the contamw nname Hw rmwLw]am a
Mermalthom memMrwMxmee anaubie,mcm Into,"n,alandaame.INA INA mA p *"M Yga maaylal,rre
0ewyllA4 eYPlb =ame61,xTM swan thin wat MNR,NYerwnWwr.
yllo rymen iW reasonable terse mdo w mthe
a chamber, but some ml mal dust and maidua wall I'Y AN lehbennd`Me pemamry Mllamawte i'OdI and
foreign msYnal homthertmnna and MmudxYl aMMMn m will be Mapmetlotat YyuirW yrhmI
cl�atM I,malns will be mien anl,any ouluerved also small Pieceav PIMMI Inma O"nBW mMainvoruT.Cwana>W
nsgeranlh artylaaehW mal mJryle h nt 15latCEnlwbl,as aYlWy ffi m.
OPENING OF CONTAM01
The""whers'may mNopen tM COYim'hddlss the mn MMQwtl human remains in real N,urrdanw;such as to
confirm rM Menteyof the hawed or to emure that Bar material&OmW µMM might letter amPloWes a,damay
omoanY If human rw sam"l Ina wad,m a m iaw
NMI twF lMtrem gWfll rOOMl leer WWaMdlnbasW @m MWWg Ra=WN lwrrm The
Oomlrgof a cOnYlnerwtMtranxl¢ronemowl Of remains Wlll be amducled whoa,a wene9 and will be done M OrIWN,
with dignity and waoact.
HIENTIFICATION OF ^OEIN,IALIEO n\ \ p 1
Named Oecacud: L LQP 1/Q� Malbl BleWa.��'a
Late Nnent Addrex: 4yry_IC"- 'Ilic,4 Yp1bn1 L?1V LOWC'GQ ^,u 1a lies
Place/eal�DA4h: to �C.la..a_- 2c hrn/ �—��
Sri: VA OF M'll DOA (J a DMeofDxgt��� EFd AwdwwgM: l-tollri
OtxdMm,0,WMW/ ;ner In W&raw me wits be detworM:
bea ,II
PERSON IN EONTRI DISPOSITION
lPermrdL)In L»vN of dNP itio nhYI ONF the kflm"l
_r aM We are the d,sienatedagent Wthe deaaga 4dAmAwd in a wan or written lnammm eacuwtl PvnYM NO Publh
Nealth Use f¢ 4JCOg
(SS ahhe M krow ge that One decease eeMN a widen instrument Pursuant Y PIPI Heats law,X on 4201 or
firs Be AM the dIgnishmn N he Or Mr remalm and(Cnmlnu1yWdrl1aeaM Pao)
ma mlw.oy w �"— tkLilio N—)al
Ed I {garL9C9tg a cHlweunilaT ciLWYEgIPY
RdLg:W 02NAVLO I]Ml303d
IwrMare the pneonlel hawre Nb.dyumlar PuMC Naar Lew Whom 001 and hwe the dam to amronm river
of roes remark offers,reviews.writer Mwims 'm w are d rimi Ie as raaaa,:
ryamnom meewlwawl
Plumbee 4j—oeeabdon. Tz&
A pwmnrdeaanamd rwrhmB pureawasW pptla nwashrM wassearsaxol (a)i
a Tneeurvivinawuse;
N.The washing domeatk hanrer.
th r iwnp N9tl egnlan ears at no adder
lWhining parent.
€ Asurvieiapioo;M1OnlaenyeM Mpe or olex:
fl AIgMUXy appoints 9ueNian:
is Any parsoniaf el�rF.n yaenape VOtlar¢ntltlmmNlere In Te Mete anCwMlelera cleaeW In
' releeonanip to lffeMreeeee'.
B. AdulyepWlnts Stlervewh has MaG
9. AdwelnenE or reserve w11e bsaemwtnea wrlMnabbmt»t parwan(m PublicMaM lax§4201 p);
10. ACItMf dalAmaamuMyme Wdlc ebninbvator ppoimatl prwenim Me 9umBalaR Coud
praeeun Ad;
to..Anr em>p whoFxFr9 an INrallIXma eeceaswafro who ho wwcaeo awnttw ddemnt Wrsuant
b f"AP Ylr lee{§NBIQ�.
accymefodawna
enareby'. mmatthe mdya this eo„aedoes not confirm a barriers,bases pad[ Waver u%aeba[tne
ImPant er mdiwahN dmia will that art,such mashwa were mewed prior torte wasalw of this Authorization term.
(^r��tlNN Nemr prior w emptlpn meY rare[F Mrm b eM vemewry eM[rcmeby pnawl.
ITMa MrebyiaMrm that lwnmwn haw Mn jMh wpmuarm.emn [�Fne/Iamgaam residing the
wai Iman personal Pithiness a are,thra aralaewh ih,ny peron dai Eeluu w arty hmily member Of the dereasM
oishK[O paNrve. wwwmmmr isna rmiss @ for remowl of smasher
irons from On wnuFei or from Offer remmns of the diessee.pFNar Mra let m the[Msner aMu me Nmanawill ee
Oy[M vematlan perk end wsral M rerrinM erY kremkM.
d nNeeYMtMrI6Mnvnrrarn.J Preview CremYnry wvweNlMreuiv of
mmlw,ww L
P Nu INsmanw
TM Wrson wmae:aam rcoalPw me emmatea terrors ameaaa.ed rtanr meaenNlay Ie.
Nanq. ^WrFuneraltmrre Perxxve
AddrMa 11 LCMN@Sbea buenabun Nev VeF 1]&N plays'. 1518 r61A
TMCIana1W remdn6 aeeM�at wYl be d4mMtlIXa9plWe:
Rrbrnmmmhym Maem.d
nanny IMepn aw pemp Mntw alN.emM naaXepoaeamlr ameaaretm mnma,
r=eawvr�ma P vcrnrrNtaa ewtromaem BNe powvaFan IXmemrrmMm
w..a...,wa1 MY.n irrnwduom. Maa�wa�ryarP,,.r.w�r opt enyv�,e,,yso['ereemell.
sit
qe - 11p0,t9[949 armHlareune tea e4t�W Uat lnr
R![4 p OZOZ/9U[0 13p1393C
�V/ NJe tlersAM IMi NIMnnleYti@Ml Qtlmp XMllF t'N pBy9NcaMpn.
! JPXC VMw Cremehn mey L'gFgpaf ryy lMnYM hen vidrHwbY rrpnnv.
vuN u Ly scprgrynp,
r AWAnoy c_ O _W
("nN cwa efrneloYMnpl
�n um hW uapa as amwxer qr me cremated mnams ads Seen Whasea nom isexr
FurerL Homy end is MavIRM as Mbvs'.
Rs ulderw�d slatltme um Is Teo smell la 1wm ue ervrre amvtm remelrs, en gdY3MMrgp mnryllyse0/MIpM
1 ,J� as nRyel Nell WrtawH.IMY urpeRlend NH"I umueR Maddm gawp}e prgW detwiau.
aoRalne.mreew.p. wl qm'a hn wemmerwnweb ergle teminnry
Tell wtamixw n FarMwmS pmJded by mewenwr.e.J faslvp mertreaem
ap.Jepapea.J ;i leMerteslred�ueenWve Hwv yoht end is speed b/ne N"W Sensor
as wlSnas ro l6 pMe:ulgn
ONS aevp recervM a Tmelet.f mff&Om Aum tlpn Fqm.
The PSIS (44pyillTgC(ypa.yore NpPsrsmlfa m m'tlsd adagVEeq Wm by adge`Ji the AugWpaeyn
T r nMMa SO Me adds NIRNm.r nmRMey M MU NM Sddd ShanW
auManxra Ma 1 Awtw
ma � tl
earnla L T
syn dryer .10 ess
�\a uk A„e UAti4 . L nV\ata3
MMESS:
f Ssla ReBehv
e..vrsaws..rwmawaa.. vv
F nemlH lle Mts90
I
mar^s'u G 4 p"' L'weYssr
'd pp0pLB(9L9 weHlenunjx'� nZ460 CZBI IT
Milpto DOZA lLB MIMS