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Quakenbush, Richard Michael Pine View Cemetery & Crematorium Quaker Road Queensbury, NY 12884 (518) 745-4477 or (51 a) 745.4478 FUNERAL HOME: �jfgp RETURN TIME: _ OY/L DATE & TIME REMAINS ARRIVED AT CREMATORY: 7�.9 _- �wto 93B,4r1, NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAIN31 _/M�e 3 NAME: A.GlA", /t'b. ./ . L F� GASFp A77 TYPE OF CONTAINER: yf R O / WOO Cn PLACE OF DIgTH: ._ 'Sy._ L 3/° ESTIMATED WEIGHT OF REMAINS A CONTAINER The Sm &Re 131/A/As PLACED IN HOLD: PLACED IN REFRIGERATION: �4S'/yyEL_ DATE OF CREMATION: -% 7-9-yam TIME STARTED: .--&O_� TIME COMPLETED: _ 1 -"C .L PLACED IN RETORT: /.lti PL__. .—__MOVED: I 1-�15Oh RETORT 9 IN WHICH REMAINS WERE CREMATED: sl^ / ofvAe KWL DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS FROM TIME OF ACCEPTED DELIVERY: NOTE: THE CREMATION LOG SHALL BE RETAINER IN THE PERMANENT FILE OF THE CREMATORY. p¢pamment of Shia* NEW YORK Division of Dg MN of N9MEre0^EI SPATE Of CY P °PP0Ri0X1TM Cemeteries Tel Many, 1066216 Authorization for Cremation and Disposition Thk AUMarlaatlan Form must na completed and signed prior to aellwry of mmamsfwcmmaEon. Data 07/2512020 Number. 475 Cmma Name: Pare Meu CMMa Mdre 21 Quaker Read oueenebun.NY 250a FhoM: (518) ASMn CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS. Cmmadcn ie limed held by plaung the remains me decease and Ma MmW among W remains into a uemmon WmM' M M%eKfuLjeclM piMen9a t981 antl Seme. The butand Nma WII Incixn and consume aaaryNing eawpt WOs and"ol. which are all Mat will be MN other rnmvtlon. Followlrgmematon, me cremeldy Mall take mawnab eftrsto tarn lice all of ben remains and of material Them Me common e mber but some mammal dust and residue will IgetyMleft behind TIMEcrgnabry will wore ineidannal and brepn mabeal Parr Me remain and me moeeMal and normal matenalwlll be dierased mas recuiad by law. TMmmaR tt alnsmllbemeG nitllly pulueniee InW mall pem¢and placed i M a dwig"W wnlaiMrG um. CmmaWd remains genemlly am pul"dnd undl m single fragment Is mcag niaable as skeletal dews. OPENING OF THE CONTAINER The co mabry may only open Me omlalner holding me uncmmated human remains In lwrad awmstanm¢.wtll as to confirm the ieendtrof Meeeceaaee or W ararre that no mffinal'a endorsed whlM might injure employers ordama9e the aemeWry POM It human remains are delivered In a conger whash Is rKK sufti for cremation such as ceremonial co nceal mb dx Harare WING remalM ba mMsd ImoaeuhbM re aYlmr and Naisca Ms Afacy, w Theo4aw Wa defrayal MMrer or remorel m remain arm M ahenerama berme a wf me.a and w111 M mid In pduary,Mace ag niry and reaper IDENTIFICATION OF DECEASED Name of Oeme9M'. Richard MlNad Ouakenbuan MBWISMbM, Memee Last PMrem: W Pyramid Plrin Estate SaraWga $grove. NY 12M Place of MMh. Sat 2 Ho l Day. ©M OF Age. 49 Dos: 09/07/1950 D.Mmoe.m: 071261 a Esnmame Me M 168 Description of waakelcontaWer In whim remains Man M dekwr , Cardboard Box wN/o dden Base PERSON IN CONTROL OF pSPOSTION f owersol in canbd of daw.nflm, sal ONE a Me hWw.vlp) I anNb am the designated agent of W Mc d emigMMd in a as or n n instrument MccuMe pursuant to Pi Hj}\OWMMM Law Sastan 4201. }.g1L— IMP have or knowledge that the Messed esecldad a wnlMn im=meM Pursuant Public HeraIM Law Station 42010r e mng director Or Of dsM w of his or her remains and IhM ere W Mmon(s) M1ll ptpmy under Public Heats uW sc'Gont4201 and Mre Ma rgd W aumm¢e c MOM of the remalM of Me�aeed. WIDur mlauonanlp to the deu$"e Is as follow Richard Michael Quakenbush DOS1598uf("end. 04120) Page 1 Of 3 Authorization for Cremation and Disposition (our hm me gR mand) Number'. 2 pescnp4m; publish J. Quackenbush (Spaurem 1. A phoson 0eadfaletlln wriong pursuarR ac Public Health l8a5 on I2(i; 2. The suriNng Money.. L. The sum eamesm partner. 3. Any intend chid aphkao yMO of Me or Older l A swormina parent S. A suruiving siring eMM nyears M age or olEerl 9. Al part appointed guanllan', T. Any preends)alh nyears of age an dOm mN4tl b share in the Maple end who Tome cbetl In mebrany to Me Oleaed, B. A dustappoindE flEucdry of to eebb: 9. Atbae Blend or relative wM has ereCukE a wrlMn stMemeM pursuant to Public Heart law Saclkn 0201(7)I 10. A cars RVl oMwr of a manly or a public atlminkhator appointed puraant to the SumgelO S Court Procedure Art Has. Any oher person who is Ai on behalf of tM measure and who has eeealed a written st of puRWnt to Public Health Low Section 421 (I A(1 THREE of me hardavg) IV IAY9 hereby Am Net the Harry ot Mar de smsed Meg nor handed a battery, battery peat. parrer deal gdmm ve meant oriadrm<ve MwB and Mttany such Ideal vrers terraced prior b Ma enrolled airport Automatism Form. Fellmeb Nmove Mesa Items Moi<nmellm may molten arm better crematory and crametary personnel. sl1V b`AB ai that rnstNdions eve been dean to ROIIaM G Hncag maydr ire to removal of any pemcnal pmpaRy or other thing of value which anygraon spring baker Or ads body member of the deuaeed wiphe9bgeserva. PIntY CemaWry, orreal u mlr9apanab4 br Meremavel olpaaoNl ante kcm me mMaNermhom Me remein¢altha tleceseM. PamonalNmalaRen Nn do Ider<r w1M the remalm adn a deadayed M M.<mm.mn proms ana canna a rehlawa amr rnmadon. IM'a nemby anNorlea pine sell Cwamdacy b mmm Me remains of Me Mcmaed. (Ii OPTIONAL) Vvn hereby vuMotlie the named funeral director b pmvitle for delivery band cremation by an albmm customary,Hdwr new¢aary In Me appears W Me awn l director,and No amend Mls form Thaida Me mmct no me and addmsa of such aMmab thromb . FMALOISPOSITION The proem aulhomed to Raiw the mmadd mmain9 her Me h¢ased horn Ne=M=q 4: Note Compa¢¢'wrgb Funeral Care Adder. 4D2 Maple Avi 58raWga Spdrys, NY 12M phone (518)590.a9aG The uemabd summers of demas wil W dWa of Me beans: REPARN TO FAMILY If far any mono tfre parson nwrnd aWe deals not hb ones lofduem remehre. Piny VW Crematory he bilMaaM 0 gal Wesw4onof Me amaim0 n>emrxuex Lanpeuiarele Funeral Cam, and by delvers In pr¢an V by NhfmMmd mall ~� Ri MMVMwI OMkeroush QOSIB�IIRw. gN201 paws Page 2 of3 Authorization for Cremation and Disposition tw�y�aa OW) 1111—WIa untlFabM Mile i11heine me net ne xiMn luaeE lloaan Pe ntium. Pure viverew cremerory mw a.p®emM.�wnalreM an uMnevapk Wander, level as by srtllenit mu,xum.mn CM MN CONTAINED M bind ONE o tde Sabi An on ble used es a mnlairarM the onmabd aim M9 Coen Wemoss own India dewrmm a,Ware: WA Oda that If Me um R,Me Small to hold Xe w mwm rynems.an MdAanal and mna er may we used ror dd Ms M un onNyal W WlaSed, INYp uMerslaM MBI Mn0 wn ie Wmhero]woVewlae pWvldsd Poet CreWelory �.waa.a�n will pmae Me oaWetee remem,M a fBM iwnWrary mMaroer he d&cary. Thl¢AUMw atl Fonnwa¢woMedW FbAMndG Hi was consented at Compass wte Funeral Care, inc 402 Maple Ave. Sams Scrog0 NY 12M mww� a Mad algred 4 Me woral cracker wllres,m ha smwpon M INA have rererved a mMdo d mpy of thle AUMMOaN Form. The personal Identified blow,Isis re Me panonis)In control Wdspas Rion.who by signing this AUMorap Form,&N92) M Me mmi and cam plebnsas of Me Informadon CO inW In Mls AU MzaY Tom and auMeN s)Me foregoing. 9lpned this 28M day sUrv ,,2020 1 1 � \ Deborah J. DuaMenW,h ,,,Al 6NN �A 1Urf IL "0 Poll Pines Esove Swaomo 9enrgs, NY 12" $� Tes",p"awnw, mass. WITNESS: ^ „ ^ Rolland o.�Hset w y 636 RkMk MlMael Oue wbmh DOS-1690-11Rev 04(10) pal