George, Scott Joseph (2) Pine View Cemetery & Crematorium
Quaker Road
Queensburyl NV 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: _ s $_,P_ __
'- RETURN TIME
DATE A TIME REMAINS ARRIVED AT CREMATORY;
_ $ Sm Bar
NAME OF FUNERAL DIRECTOR OR REORISTEREO RESIDENT DELIVERING REMAINS:
NAME: _______.
,L .CASE R
p
TYPE OF CONTAINER: _ _ rMq
PEACE OF DEATH: _ Z I_g_(�,II.I• �..+._ Q� �II MI 91XI
ESTIMATED WEIGHT OF REMAINS A CONTANER____ ZSZ I�r
PLACED IN HOLD:
PLACED IN REFRIGERATION: _
DATE OF CREMATION:
TIME STARTED: . — -1-7v Ali TIME COMPLETED: "1 Sin
PLACED IN RETORT: :30_AM -- ��
_MOVED: _ Q 30 9;
RETORT 0IN WHICH REMAINS WERE CREMATED: — s.—�yT� Y
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SMALL Be RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
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Abithorintlon for Cremation and Disposition
TWO AYMOM Form must bs competing]and signed prior to aaliverrarmbn M[wma .
owe: 07/31/2020 Number. 115-
cmmpory Name:Pim View Crematorium
Adnreas:51 Quaker Road, Queensbury, NY 12804 Phom: (518) 7,1
CREMATION 15 AN IRREVERSIBLE AND FINAL MOCM.
Cremation is camas out by placing Me remain of the alcohol and the container b kfing the Del into a tlemaing CNanbxwlwe
Mal are original to Inlenx hear and name. The hart and l4ma will Inclmnto and conslmnewryMlnp all bona W nMY.
walch an all Met will as IOR star cremation.
FoloMng crtmerlon, Me =m=q All hike reasonable elbnslo remove all of the remains and other metenel from Me aemMon
Member, bNao the reontosthe
minl imel al also
l a MkereNdumeavAI ni.l by
telldeed a. G, Land by law
The memuldnaaml e md bwill igen mNMMno
daressedThe ally
Falsehood intosurnal
pectsandplemdIntoa designated consumer or sair CnWnmaimpmmllyamWivaWuMin Night Is rKOgnYblp As sNI NUe
OPENING OF THE CONTAINER
The crematory may Only own the Wmeier model the unLRm human remain in limited deumtlal such as to COrMm On
Innllly of the damaged or to ensure that no mffinal is annul shown might injure engloyees or damage Me ammmory pmWmL N
It area rigs no are dellvand I n a coral nor which n not so stable far c mmabon such as seasonal or Metal mawh Me
creematory will require that the remains W moved Into a euMble mnalnv p m H accepts Me mission TheowNngas
wmUneror Me transfer or removal ofremainsvmlbemndu Momaw en8WWIIWdWe ,n tinweY, w dgn4and aspect
IDENTIFICATION OF DECEASED
Name of Deceased: Sood Joseph George Maa i stwus: Manned
Last Known Addrwe 27A Depalo Lane. 9ueensbury , NY 12804
Place of Demon. 27A Depalo lane, Gueensbury , NY 128M
Sea". ® M 13F Age: 42 DOB; 91/04/19]8 pale a Dw 07/30/2020 Estimated Wsight
Deaen ton of wekW¢nrBMr in Mi amain all n MI ,
�� o0 9 w in M AM ) 1
PERSON IN CONTROL OF USP IVON
werach in egNd adoµ Wr mhlur ONE mayor Mbwrp)
I amMle are has designated agent pass dxewN designated N awgl or wagon inNu exagedp Ms APubic;
I tBw Season 4201.
-OR-
r—J]l. NNe hew w Xnowedge MM Me de amd execNM a nImirumem Aural to Public Hearth taw SMkm 4201 «a
*III wMBimre directions Our Me dlspnnbn of his or her remain and INe am Me Wwnlal hanng phrvlry under Public Henke law
Semen 4NI and hew the right w small cmm on 0 the ral s the Massed. ay/Our relationship W this dxwaad to
M cow:
Scptt Joseph Gewglp
www
MS-m%f(Raw, wao) Page t a 3
Aothorintion for Cremation and Disposition
pnwrt mam we av deal
Number'. 2 oeenyuon: SPOUSe
1. A Farces Oeaignatetl in wing wisdom To Pu0lk Pont Lam 5Mkn 4ID1(9):
2. The surme g spouse:
L. The sural domestic moral
S. Any surviving cad climate years d age in Well
4. Asurvrving pared,
S. A surviving sibling eighteen peas otaga 0r doer
F. A lawr a ppomlM qua rdienl
1. Any renonlsl eigmeen roars M age or open probes N stem in Me estate and who ✓are closest in samurai to tlw Eeueaed:
e. A baby appuintl fidudary W Me aces
e. A come Mend or rela4ve who has aucuhd a sudden dMMNm Wnuant to Polk HeeM Law Settles ANT(T);
10. A MM tonal owyr of a Tommy or a public continental arrested pumices to Me Surreal s Court Personam PA
its. My Also person who is,acting on ter Athe demand YW wM has conceded a wrMen element purposes W PubNC Heats
Law Sedan 4201(0
l.M�it-gi rALL Timi Wthe MNxup)
\ft me hereby affirm Mn to body aMe recessed dons M mmam a whom. battery pack. power mil, ndiowtin lmptam,
to radioxtlw move ,and MT any such meters were removed pm W Me ueMicn W his Auwo ma Farm. Felon mrwrwea
Mpa IM1m gbrto cmhNlon may mount In Nrm to the nameWry ono cemetery pesonwl.
INye affirm that namra'wm have dean given W Weenndy M. Bulich
regarding the removal of any pcmonel property or Mu thing dadds which any mson signing Eehow or any mnily,mother of the
dereased wishes to prenrn. Pine View Crematorium
rs not mponsible mrtto smovalWwr.onal llama M1om Me comalwratantM nm.inaWMe denim. Pamwulhemol In he
container orwnh ties remains,Tots be ae.Myad by me cmmence process and canna ba represent characteristics.
X �Ir Ilan May sdbees Pine View Crematorium
m ar.m.e.Ma renwro a dra aeses..e.
QnRI✓OPTIMAL)
lHn hereby authorize the named luwral director to pro l0e for delwery,to and channel W an aMmda
nualary, Hdesmed antibody in Me opinion Mme formal director, and W amand this form to prnide Me correct happened
"time 0 soh adsorbed,concedes.
RML DISPOSITION
The pesos euMwizeo W mwrtm the ogreled mwim of but tlemnN M1wn the mmmcry is:
Name:Singleton Sullivan Potter Funeral Home
Awns: 407 Bay Real Oueensbury, NY 12804 Phow: (518) ]g8 g
TM morel resin d dwrened and or dbosed a as papers'.
Retum to family
Hl My mow rite mrnn nod aurae adds rem aka pmnnan aMe model remeiw.
Pirre View Crematorium a auuwrina W give Malawi a
Hreammiad Singleon Sullivan Potter Funeral Home by happens
In mrnn or M ap:ml mail. Scott Joseph George
nnStassi doev.o0.Re) inn Postal
Authorization for Cremation and Disposition
race me kdNMq)
Wla undenund met UMe hall an mrmimad within 120 cal ofcremetbn.
Pine View Crematorium may aepaee a the Remains
an Merrill manner, such as ey Rstsenrq.
LPEIM LOMAIXEM M
lapel are adre rarowlagl
An dm to ee deed as a omMmr br me uematad names has Iwn Vumhre ed Man
and is deamEed as Real
Ii understand lhat 41 um is ba nnal b hdd tlro amn aerMatl rtmvin,as addi rpB mlLLynr may W luM rw bYusy.
M um w red yet Wtdfnal tMN VAweYM mat X he tan as WIWflM womerwae provided
Pine Ywyw Crematorium will pace the cremated remains in
diminishment
v rqp remparvry mMviner br dMiwry.
This Aumodaatlon Form was prondad W Wendy M. BUIi& was newtod at
Singleton Sullivan Potter Fu en ml Home
W Bay Road Gueens 4 tal NY 1281M
.a•tiw
and is sigma ImMe rumml direasm aawnssW day eedhpnna
Man have reserved a Wm(leted WpyW May Maternal Farm
TM esteems)Senegal bell plan Me immoral In conalWdlvpwltlon.who ey signing rhb Asmywmsdon Form,a gs)
In the vccuncy sand immaNbal ahe Inlmnlln eOmalread In this AUMwravdm Form and addraliNal Me brpoep.
Signed Me 31st hal July ,20/ 20
ica a
Jess George 1 \� r yw� as, CJ/WY [Q�CAJ�'
rw+ s "d
21A Dapalo lane GueansWry NY 128g4-
YnynFag:
Wendy M. BtAch
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10041
Sw8 Joseph George
tawasr
XrS 18981(Rev. Mrzm Page303