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Authorization for Cremation and Disposition
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cwwmW Name: Pine Vow Crematory
nm..e 21 Quaker Rd QO fwmsI ry NY 12800 From,'. fie aA L/977
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OPEXNO OF THE InderN"ER
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OENTRCa11O"OF ME EO
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t,g Nmnr Adaea: Sydrederman Tdeare Jay St Game Falls, NY 12801
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FMAL 0ISPOERION
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Nl Alexander-Baker Funeral Home, NMI AlexaMer
Adams: 3B09 Man Steel WarreneEurg NV IM5 PhM: (518) 6212065
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Authorisation for Cremation and Disposition
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LREYITLN COMNNERNXX
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Abxantler-Baker erel Home
3al]9 Main Street Wanneveli f2Y 12M
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CSFINA Silva X � - • A A /
27 Went Mystic Avenue. Myetly UBSM
Anne
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10034 'nawOM^'
Maran C.
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WS1aXM1l IXm.IN2J) Papn]o(3
Pine View Cemetery & Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (518) 745.4476
FUNERAL HOME: _ ///
!�_--- .___.._. RETURN TIME:6?%h
DATE A TIME REMAINS ARRIVED AT CREMATORY; _2'JaLZa7 f,IP�
NAME OF FUNERA,Ln DIRECTOR
//OR RECRISTEREO RESIDENT DELIVERING REMAINS:
NAME:
TYPE OF CONTAINER: 00tIcI___d_Cyf4e�pt
PLACE OF CEATH: _CArLN/� ,�/ II - eJ-/• • e Nr �S�Z
ESTIMATED WEIGHT OF REMAINS A CONTAINER__2-5-
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: 7-7-8 �ZO ZJ
TIME STARTED: �0 `/5-.4M TIME COMPLETRICH q
PLACED IN RETORT: _L45 AN. _____MOVED:
^
RETORT A IN WHICH REMAINS WERE CREMATED: VIREM/Y C'Ji
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 4E HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL BE RETAINED IN THE PERMANENT PILE OF THE CREMATORY,