McGarr, Patrick Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: RETURN TIME' . 70A�
DATE & TIME REMAINS ARRIVED AT CREMATORY: - 2-3/- Z7j
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
NAMBEr
TYPE OF CONTAINER:
PLACE OF DEATH:
ESTIMATED WEIGHT OF REMAINS & CONTAINER__ /V/2/y$
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: p��7 /- J Zo d
TIME STARTED: _ O ryJ ALM TIME COMPLETED: IIHO AMI
PLACED IN RETORT: MOVED: 1110Aa
RETORT A IN WHICH REMAINS WERE CREMATED: aoum/I4/C-/�'
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 40 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE THE CREMATION LOG SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
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EWYORK Division of °^^"°MO DP welklE Per,
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Authorization for Cremation and Disposition
They AUMwluam Fam nwl Y cmlgebC atl aI W a plar to EeIMry at"Wild"AN crwr W ten.
Data OM012020 x1.nM �i3
Cremabry Name:PI11a YAW GfB111a1D1i11111
Amrem:51 Quaker Reand. Gueemai NY 12804 brow: (518) 74 77
ORFMaT IS AN IRREVERSIBLE AND FIN/,L PR°CE
GtlnaYon is mm Wl by pool ng the remains of the des and than comener soloing me remains into a cremAon Wmoerxlme
they we WNacoo N Intense best and flame. TM beat and Nma WIII Inclm M and camuma sverylhNp okapi Wine and Mae
whch are all Age will be left ebar C1M gon.
Fdlwing cremation.the Uemad ry all take reasonable enoN W remove all of me remains and other magarral from Ne aomation
chal but some minimal dust end hman wil likely be aft behind iM uerrubrywill SeWrele lmNenLleM loregn melelvl holm
tMremmans and ea smsall pIx a and model iiinto ateral All as d�D�0esgnatd usured u�Ied'by wmted�rmim Wnmllllysn remains
WIreInMumnoly
&into hagmem at mat ria as skeletal hmm, mum
OPENING OF THE CONTAINER
me crematory may Only open the comment holding the unuam human remains in limited crwmwnas.soon as m confirm the
human
oemains am ca ort ensurcmatnameonm i Is not sad Mhtfor gm in� empbya ceremonial
eremo Neutal ca this . n
sigmas remains am d,Death In aiums moved Rana vu Woco cmmWoneR m the nlalnirentalwMN,1ha
rematorywillrpulre Mrttha nmsimbamad h Imoactb9comalmr Mare Heceepb tinrem��n�. daopeningma
mnoiner or the ttensM or removal of remains will bemM tart bloreewMem end MII bO Genets pinery, Mlh openly and re¢peq.
IDMIFIDA1140111 OF DEC 3E_
Name ofcewazm: Pal MCGert NNmISLL s'. Married
Lima Known address:S Ripley Pi G bury f)4 IZtP4
Prow moaaln:Glens Falls Ilpsprol, 100 PaA Street, Glen Fells, NY 12801
Sae: ®M OF Ag: 68 rl 0811&1951 Caledonian: 0n712912020 ELLm Weght�
Dm�mana � mywhish,
sal
TIIOL OF DaRDIN ION
fpwmn(911n mnlyd of wig ,, lime ow,of IM mrowMy
I emM1Ve we metlmgmtm agent of the 4ttextl designated in a will or written instrument execuwJ pumuaM W Publk
Hlealththh Law Season 4201.
�}',r� I1 have no dimensd2e that the de2aeetl eaeurko a wmmn ImWmerl pumuanl to Pudic month Lew Section 4201 or a
v.111 d taming oirec4ons lortlre dwerasition of hat or her mermen and Ind ere the Wrsm(s)having poomy under Pudic HwXh Lew
Section 4201 end laws the rind W aNninum oriental of tM remains of MB dmemd tabour misl hip A Ne damsad In as
leltw
Patrick McGarr
WS-1 Ell(Rev. GATO) Ppe t Of
.Authorization for Cremation and Disposition
preen Mmme kM eeroa
Number: 2 Oesolalm: Spouse
L A wean designated In wil queuent to Piaio Hal Law Becton 4101gh
2 The survniip apouw:
L. The surviving 0anento women
8. Any surviving child eastern years Ol age or dden
A A surviving parent:
i A surviving sham eighteen where of age a old
8. Al awfully appointed Mariana,
). My persoms)common years of age or order mtlea to share In me ecare all who aware cluster In reasonable to the decimal,
4. A duly appointed fiduciary of the emote:
9. A close trend or relative who has executed a written statement pursuant be Pudic Health Law Seson 41
10. A chair I officer of a owny m a Wblie adminidammy appointed pursuant to the Sunoaate'a Chun Proxmire Fat;
a0e. My other persan awls aping on behalf d Me deceased and who hm executed a wrNen members amounts ro Pudic HMM
law section 4l
( ALL THREE a fed ldbwmg)
INS Mnhy affirm that the EWyof the thrombi does nth comen a deal bwi pas,power mil, r dmotors Impaant
orramenta a Moody all that any such nationals were remmred preambles erecutihn of this Monsoonal Form. Faflum b renwse
pnormcmnaaonmymuXlnmrmWMew ma mMcrm"ry omaX
IM'e afirm that imlructionahave seen 9M1en to Wendy BuliM
regarding tM removal&any m rsonal pnrmq or other bang W whom ass arty person"I I M ell family member a ge
Mciamd wishes W preserve. Pine View Cremarorium
is ml membrane M the remonl Of personal items from tlw vermin w hen they mmeirs NMe meeaeaM. PMoreah Xema lea In Me
erOr wed remelm an Me he dehremd by campaigns mbn pt s and unn& ma M abnorl aflar otherwise.Me meant hyffivi Pine View Crematonum
room bcmm Mere atlp aacwawl.
(named( PTIONAL)
MW Mrsy ruMonaa the named Nnerrl almost W pmvlEe for deldery to all cr ton 4 an albmeb
cTwlorh Fdxmed necessary in Me opinion at Me funerzl charter. and to smell Mls form to pomlM Me consist name and
ed of such aMmaW c mnatory.
FINAL d WION
Te armed abMnZBM W receive the mmated remalM aMe MRssea hdn the u Me "is:
Name,Singleton Sullivan Potter Funeral Home
Ammer 407 Bay Road, Cueenebury, NV 12W4 Phorw: (518)7g3-045g
lse creamer 1 meta of debased an se dlspwed d as fall
Return b family
If far any waecn May person named aWve door eat bed pwemhm of be Me nnWns,
Pins View Crematonum is auhuiad be 9"pmmsbn of
oversew, N
the remained Singleton Sullivan Potter Funeral Noma Myds9swry
In person m by magazine maK 6sw a Paola: lakii
,w.wwh�e
OOS-189841nev_0ot PattBd3
e
Authbrivition for Cremation and Disposition
MIDWIM)me
IMb understand lM IF they amine are nor chimed wain 120 dare of eemation.
Pines Vim Crematorum may d'upose of owners in
an nationality rrmmer.Meet as 4 a4Mdrre.
LREWTON CONINNENORN
(lnaa ONEWIM Mlawingf
M urn to the used es a come er W they gentled rxmns has Mn puMased M1cm
and is devil as tollowa'.
May understood Met if day um wtm anal b had the er2n pematM rgrers. an s lditionel dpk consumer may,be uN la deemry.
MumNrodyNwr . t ubratand MadmumionpurWsedoroec g dW
Pines Yew Crematorium mll pare me cremated remains In
a ritincl orarY donations for dalli
finis Aunaaadan Form wu remedial W WerMY M. Bulieh was executed at
Sirrileton Sullivan Potter Funeral Home
407 Bay Road. Gu renebury, NV 121304
and is sgned by Me Nronnl dire dor as wamss to its axeatim m..a+r..e
Why here mori a mngleni dopy of Mie Autlrorlallon Form.
"a penon(s)Mx Wblow plan the panona)In wmM of deposition,wM by apnlnp Me Autlnrlueon Form, abets)
to the Motors"and complae or Me IMwmation cwathei In this IUMwpWwr Fam and WwNale)1M hirpolnp.
sigma this 301h dsya JUIY , M/y-3�10
Lorene McGarr
5 Ri*Y Place Gue ury
n..a>nw.r... aw.
YIrtNEb: I 1 `
r�.+owr moss Wendy M. Bulich
10441
PatrakM rr
w�wese
oos.teeallRaa.arzlo p.p.sas