Hoffis, Edna M. Pine View Cemetery 8 Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (510) 745-4476
FUNERAL HOME: AB_ NK __ _ RETURN TIME:
DATE A TIME REMAINS ARRIVED AT CREMATORY: lU(ID —
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
200 �try MVP
NAMEt W8 yori /' CASE 4 fig /
TYPE OF CONTAINER: h :E Qft F.�_ x.E_ - LOAF 4 IqR (LR*,or..
PLACE of DEATH; 311 BP,OB0A1N Magi � 9 µ/1 121iQ 1
ESTIMATED WEIGHT OF REMAINS A CONTAINER
PLACED IN HOLD:
PLACED IN REFRIGERATION: /;0D Vll
DATE OF CREMATION: 7II2
TIME STARTED: 7. ZP AP _TIME COMPLETED: RIOT;:^'RI
PLACED IN RETORT: MOVED: S:/1A}1 Q'E7f[(pl
T� 1
RETORT p IN WHICH REMAINS WERE CREMATED: SIAH R:Gt PUf(
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 4a HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
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Authorization for Cremation and Disposition
They Amhwi wOn Form must be wmdaled and shares Free 0 delivery N mnama loruncommon.
dram:cry s,2ma nuro.r: SZ6
Crunarory Nam HIM Mery Crxnebry
_ 210uaFar Nam Cueme[ory, FMe Yak 12934 Phase: 5la•]JS8118
1
FMOWAAAmi IB NI IRREVERBIBI.E AND'NFL PROCEW
Crem andr is cane,out by Platlrp NO ramalm Nee deWased and the wmainer holding Ins anybody and a cremation chembx arms
Prey are wq 1ed a assawe heal and Mee. Tre had and nand sell Imormate and Wm: 0sNrydrlMdawat dOre aM reel.ail
welch are all must will he haft Nor commando.
Foaming drummed',the cremaramO0 lake ammonium efoM b rarnwe W of she remains and oNN mdalel man had draw n
rdem[er, om some mNimal tlust sea residue MIImary to left bOVN. The cremaray vnll aepa'am Mbdemae and Mm9n rrami arm
lee remains and she netidenral end M1#9an maMaI Yee he a mended des required by law. The oMWad remade Me br IdnYxIN
asy andtlinbamall adera'a remeannumemamlad wndimwun' Cvemabtl mnaire ge lam am wMM rmdl rro
need hammers Is reemsellable Fly skywasyl
OF THE EC(CONTAINER numbers
Th ryMnGF N opM lna WnRin¢l ndairg the YRPNntlWh gM lnlbe empbYea9mdeheege the uemebry propaMmelr
ihumanmr demaaedowedennrreroe nnerwhic is ennmae wnkn mi
human
will Nam,beady amammMnaammy W mwMCE lea sub Madmass.lBlon a.cycs�am iaramai . The op^9 m=
mmam or the member m random or remand OF W Normal hmore a aMess aM se W dam in pmary.On carry and Hemet
IQEn]FKW1U)Na Mimi
NamamDemeW:
WMovree
Ed IF media Mamal sows
Farm
l�14YNn�� 319 BroeeM'ey. FM EMnN, NY 12CL9
PNcedp'�r Fab HWwn Ni Home 319 am "FatE Nam Ywk laele
. 94 Doe. 04-23-1928 i)alemllwon.07-0 12D Emmared WaNa 180
Sax: ❑M OF rNe._
eacptidn ai rube W mn W Oar m whkn mmdre,wal oa
Florence Casket, plywood corrugated cardboard container.
usatrosmox
(Pasmfslmdesire darpWm . n�INyE are roxuwmg) -
__ eld de tl18 aend apse m1M de[as Maea6nYea In a'till awmm,ado mys,ryecuNd Puradem to Public
Healthbaw seed'n egad ua1.
eda
Name
fw tiae deaags own¢«mermnIDro�YN IMe amdso e me ommmomuls1 memag Famied or ly under Fume Hal Liawora
Issamewigdmeg Fa d'dhana antofrouw rtlWomM1iPbehe Mcu=w eaY
sealonazol e's nave men to aamwae dremahon ere mm.imdweemaaee. NN
rolhaw.: Edna M. Hoffis -
wwe
Page 1 1 i
W&18% r(Fam ( i
Aufhoaizadon for Cramadon and Disposition
MINIT'i
,so YMk untle2anE Ma d"remain are rot cooed edhin 120 drysof memaXan.
nm vaw c�amm+n pG.^.m.. li rwwXBamem�wa�.n
m�sreabre0le man�lm.wM be by watlmiN'
ewaTpX( pXI�gEXn�RN
(�0lEMMe kMwM3) '.
an to be used BB B aarmilm br Xa Gramme 2mvm+as men WNwKE MOM M 1 NanMr FlvaY Noe
UBurCM by loDoirs:IMaXenve LulbnN Mah10
- yyyutlnavElM1rt ifHn vn iBbo vnaYb mM Ne mlE2MaMed remains, an aMiOanal n9al wlllM�lmmrymuwG MtWNaP/.
M um Po MNyal W�dmM_ 1Mh undemla�d Mal Xna um LL pwMa tl a�MemYw ixT'iEm
Pyle Vlw'CR+fPory µN Time the :mmmd muim 'n
Brawmf
+npC prt¢o�ery mmam fm E+FaY.
Tea amhowna an form urea TmB'iend b LbYBL.NMrda am0 eXeul)eo ai
�m we
M.B. KilmerFuneal Home
1%Win 51. 5ouM Glers Faller, NBw YOM1 11 muavw+earn
6..ewwmm i.
ya u agnaE by Me M1aa�a OtrxMee Mhcs b ib BXwAan.
Move M1am 1e21ved a ampklM M ad Meer futllMaatlM Fwm,
The b tlN asueacy am Sm�inpbbnBw&Xe i 111114010 deem MeMem�aEaT Cmdlr�W madam ad a this Aamomrati BFarmn end ammr,,O)Me lormongs4s)
0
59red Mia tlayM2
Jale BBfomY v
135 Na isn Dme WroLk h.Ga. 301% -
WIiXE48:
Clan C Mamie Q221�
wwrnp+ry rev w.0 T �+
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Authorluhon for Cremation and Dlsposlhon
rxwrtnwnmeeaeabwl
Numbar� Gx�nMkar' A"Y Darman aalrlean rears nr An!Of deer emmm tow in the sums and rho w✓ in liamew
1. mmdeaM min amid Waawm to PUNIC Heallh Lary sedan dithp1:
Fa, the SMIMIIN domestic UPI
? Any wrviving Chid egdCm Mae of age w One
l AwrvmN parent
S. A wrvMnB amid inroad hate M mge M Near
& Aaawr y appointed Motionl
y. Any Wacn(C)eiddean years of Me or deer cri ed to alpre In the aahte and and l&ere Cla@e&In reldm ip W the Minister
herjoar, of Me media,
8. A dealt Mend or MCI,MC I,w has axavtad a whom ifamart q moss,to Rid'z Healtll
to. AChid aide oMar M a mood or a PUNIC admmiehab Leal 9embn 4Rdt m'.
iga. Ivry other person end if xti andedided wrlermni W the 51rtyatgk Germ Prosdure Aa'.
Lew MeperSedon Roen Mon Cohen of me dereaeM and xfin has exaardN a written statement pureuam m PvaiC hand
Mi AU. Phold of dm addefrq/
j"IlNae hereby m and and Ne hNy Of agz dPone rim amzn a on". tottery Me. Poeer mg, ndimclrva impiem
w mpwmae devxR up inn any sotto paler4' IsMerPUMP ptw to the exwunon of his AUMwmaton Form. Fagwa id hadpea
MxaidM ylab nemelbn may tool In Nrm to dine nr gand nor Ynonng
Aw ahem fM1MinNrenters Not been dean W Chin C.KmoW
fPeNingtle rem and merry penwvl moment Or other IN%ofwee Mf0 my pereen sMint btlrrry w ary 4My mmtg aMe
dNRYpdeitlrastop9 e. PmeviewcMamrry
la^w resWf®ICb MMa removal olprsmNilmnofiwnlM Cmmamrwa�wn the nmelrugdle dwxaeW. pafawrtl ibine leRin iM
Cd11YiMrw WM Ma nmalp vAll badnboyW Iy Mevemetlan penevmtl oarm Ip rabywd vy crematim.
heray,aemwaa Pine Uw common
ro.nr+nne�.
' to cfamNtle mralnammerleuveed
L ovnpNny
Ihaa hereby anihorize me mar ed funeral director m Perot Wr de ieery Wand cranatlon by an allemarm
amrramn. it deemed nMmMy inthe opinion elthe funmal Min mw am, and m end Mu fwm In,wor5die the Conrad new and
ddme OF much altemva Cnmvbry.
PlxAJ.olsPQ9RloN
The qnm aw ton w raalw are dremnad remains a m ,mmesm morn and wmmuy to
fume: M.B. minner Furcml Home
Adder: t]B Mato SL 5oyor Gkere FeYa, New York 1RB63 phone. 51670.58116
lM vote&d remainwevunwrwig pe aepwetlelr Nbne:
8w4t&-0eop-1. Su:.3Yera ` A . i
If bsry Undm me Para"mrnatl Mend axes nqW ywandided bwmYd rwMNa !�
Pima after Crmmtwy
�r µy �wMpzdel W per, Pnzzeeselnn of
Merenvms to M. B. mi er Furmel HCmo lift d ieny
in Pasonatyrpistmed trot. ry�EMWM. Holfe
gnaaaay
W&te%f now DWM Page 2 ml