Ehnat, John G. (2) Pine View Cemetery g Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (518) 745.4476
FUNERAL HOME:
--lKN41___ ..___ _ RETURN TIME. _
04TE 8 TIME REMAINS ARRIVED AT CREMATORY:
NAME OF FUNERAL DIRECTOR OR REGRISTERED P _
EEIDENT DELIVERING REMAINS:
PqR Y N crsg-
NAME. -"-
CASE
TYPE OF CONTAINER: _
PLACE OF DEATH: - ypy�
ESTIMATED WEIGHT OF REMAINS & CONTAINER___.�ijf )IL,
PLACED IN HOLD: �^-----
PLACID IN REFRIGERATION: __
DATE OF CREMATION:
TIME STARTED: ---]:) yy�� g�
?-Any TIME COMPLETED: q:IiS/�1
PLACED IN RETORT: _
i-44 O pp q eE� Yy{�
:
RETORT pIN WHICH REMAINS WERE
__MOVED
CREMATED: _ ors
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATEDTHAN 40 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE THE CRIMNTION LOG SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
"n"Y°RK ATf Of New"° " M
6T Divisionof OM NOFCEM Cemeteries ourplw>ventr=
nm.m.W12231-0001
Trophom:1511h4al c
wwroch,mov,
Authorization for Cremation and Disposition
Thle Autlwrici Form must be complab and signal Prior to EMlwry of remains for comater.
7/312020
Data Number'. PBH
cremnen Name: Pine Yew Crematory
Ouaker Rced, OCemaWy, NV 12Epi 61&]0.4daT]
Address Phone
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS,
Cremation N wren Out by Paring Me remains of the deceased and He Combiner thoughts She remains into a v Om CM1ember Mitre
May are subjetlM to armed heal and reeve The halt and name wnnnchneMe and consumer awryMiia except bone and nwlal.
"[on are an Mg will be Ins offer cremal inn.
PoIIowng crematbq the Crematory will take reasonable efforts to remove all of the remains
and other modern ham Me cremation
chamber. but some m finer dual and itlue call likNy be led befund The compact Mllsepmmemaidenlal and foreignform
merged m
Me remains and the mradental and breign materiel oil W disposed of as remains by law. The vmal remains wiry bemmthanlulty
pmwrpN veto novel pieces and plamd into a designated container or urn. CMMMe remains esmsralh ere pulwrlaag uMp no
$into fragment Is remainder bid as Skeletal Usage.
OPENING OF THE CONTMNER
The eternal"may only open the container heMing Me uncremated human remains In limited tlmumstances, open ae b confirm Me
ianister Me dxeased or to ensure Mel no looked is erased maker might injure employres or damage the Crematory plpemy. N
human remains are delivered In a contaNer which Is not cobble for mmatlan such as ceremenNl or renMl"I the
customary will require that the remains be moved into a suitable compter batodeclined;declined;it ac the remalns. The opening ors
OntMer«the transfer or removal of rnnaim MII be imiuMd harem a weMw.and MII be done in Chea[g wind dignity and Me .
IDENTIFICATION OF DECE M
John G. Ehnat
Name or Oemased. aI� W0
S)^mut�'s: etl^126101
IaatlNs-mn MdM ia5 Sµ /7 MI
place too Saratoga Hospital /
Sea Ox M OF Ape:= DOB: 7- 1 ' �� DM dDeeM: ]/302021 EeYnvbd WegM 125
Cmvhpnon of aaFeVvnleb in which remains will be Milos.
McDonald basic cremation container, no interior '
PERSON IN CONTROL OF DISMSmox
yoreonlsl In confM Wmap ,, yof°NE ofMa/dbwvp)
am✓eVe are Me Mohamed agent W the dawned designated in a all On wagon instrument eveculed pwspam to Public
HmI Lax sx9on 6201.
`DC IMFinan mMMedge Met Me deposited executed a mien instrument pursuant to Pudic fel Law Section 4201 or
will comps thing dir bne far the dNpnI4M of no or her remain and sue are Me pehi hailing priority under Ph N c Health Law
Section 4201 and have Me right to tomorrow MmeOon of to remains&the demased MyMurmWtionahipto Med$Ceandlen
rolwws:
John G. Ehnat
wevelmimem
DOS-18W f(Res. 081 5) Page 1 of 3
I
Authorization for Cremation and Disposition
pnmrc fr lire um hou'vol
Number 5 Cesalpsw', sister
L A"man designated In writing Pursuant to Public Health Law Sadlw14P01(S);
R. TM i uni spm¢e',
]s. The surviving eorrasto parser
S. My Michael child eighteen"am a age a older;
4. AMuvwre Part
S. Awrvial sibling agM wars of age w Olson
B. A lawfully ajdapointM Ouamla¢
z My Persomm)elahteen Pam of eye or older enbuee to share In Me estate and who lLare clo¢«rn leadership lit he dxwe9l
a. A MAY appoint] ldumary of the eNate;
s. Acdca¢hpM or mWl Who has eta WW a nstl M purauam to Public Health Law SMlm 4201;
10. ACMef Most officer of a county or a Public adminlMtor eppwntee pursuant m Me Sumgata noun Procedure Act
Her Any other person who toacting on behan of the Malawi and we,has avcuted a women sttment pumuenl to Public Health
Low Season 42017).
gal ALL THREE of Me fo ino
J , 01 NVe Mreby aflsm Met two body a the decm¢ad does not contain a hart pi pai power cou ndiouche Implant,
or rtlbactive dwlra add that we such mawdab wore removed pia b the srecusm of Sin AUMwWWn Fu . Fallun to remove
Wes Bems prior t emms nMsy result In harm to the cmMdroryand nenmtory personnel.
T, 2. VWe aces lNtlnaWctbns nave been glvenp PoMtia Miler
regardYp the removal of any pawnal proPuM or other Ming of relu ,wltirlt any pens Iipnirq below or any famJy member of Me
PIm View ctmetay
deaaaed wished to pre» ,
is rot re¢ponsibbfor Me nmovm of personal items wm Me eastern or lmm Maemalru of rho Moderated, Perwaw I WILL In tM
conWna or with the rername will be desb ed Who cremation graces¢and cannot to Main lSaar crerntllon.
Jr�Me hereby au odo Rro New Ge�Mry
m wemat the nm ins ofthe de sad. Rnwa wnr
FINAL oISPBSITION
The peen auMMIDtl b rested Me cremated remains of the deceased horn the crematory bar
Brewer Hmenal Hama. In4
Nam
34 Church St., Lake Li¢eme. NY 12M 515b96-3744
M m6 Phone:
The mmetM remalru of eeaaied will be daram ed of as phone:
uweew4.
n for any mason Me gown named above sea net orka possession of the cremaW harral
Pam New Cremabry i8 autWr in Shia Pcasession of
Ms remains Brewer FuMnl Homry Inc. by delivery
In Perew an by registered Maw, amxwa
John G. Ehnat
COSI BSBI(Rev,O&15) aa�wom.�a page 2 of
Authorization for Cremation and Disposition
_ rimatlltthe hvowmm
Rne4 VNw Meunderstand met n the remers are not thermal Within IM whim o/uermost
m.+na.�ud my dispose of the member an
an inhwe sae man her. auM the by sealtenne.
CaaatancX CON
(Staged ONE Nme hdbWnpf
an um to be used as a mnttalms he Say Cher E rernyns has Mn IwrGased ham
and is descried as blluvs:
IMe understand hat i/tho um le NO sired b had they Sh re cremated remains,en selectee!red mnWrxr may used Mdellrnry.
OR-
an vn is rat wtpacllaeed Me utlderWM that it re um a WtUmJ womerohe pwpsd
Cite Yew Chamber
trawwc.wnt Ml goes the nemetedmirmins in
a dg0 temporary condmer for b abbi
The Auaorhaatlon Form was pmssed by Patricia Miller wale meat
Brewer Funeral Home, Inc.
24 Charon St., lake Luzerm. NY 12MG
�+reweww
and es signed by the Nnmel Gmcke as wonder to its eardern.
Me he" mo ived a Compete]¢qy of Mis Aurlydrim on Farm.
ThB peracedu Identli below elM 1M imreonls) In cannel of dePosXlon,who by Signing this AYax4etlm Fgtq rtbtl(s)
by the accmary and camPleeness al the Information contained In this AuMo�hation Fmm and auaoree(a)tM bingeing.
Signed this 31 July ,zd 20
eanane Rauhl , �
eyrc e.,amwaea,NY landV
Pehltla MJlx
12466 rageennnarvwt
John G. Ehnat
WS-1098-f(Rev.W15) Page 3 of