Reiter, Dorothy Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745.4476
FUNERAL HOME:
`mPA-'-"-U- —___.__ RETURN TIME:
DATE 8 TIME REMAINS ARRIVED AT CREMATORY;
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
NAME: .._.._
TYPE OF CONTAINER:
PLACE OF DEATH:
ESTIMATED WEIGHT OF REMAINS a CGNTAINER___ ZI0
PLACED IN HOLD;
PLACED IN REFRIGERATION; __
DATE OF CREMATION:
If
TIME STARTED: COMPLETED: 11- 16
PLACED IN RETORT: A'T6RI�___MOVEO:
RETORT p IN WHICH REMAINS WERE CREMATED:
alo
PoV
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL BE RETAINEO IN THE PERMANENT FILE OF THE CREMATORY.
/--1 Careful as.n
exrroRie Division Of ImistoNOC,rusk ERms
DF w
" MNI" Cemeteries ale„earAv�,
1wa rumaywAlsl4oul
Authorization for Cremation and Disposition
This arMoruep'on Inform meet of over ply and signed Prior to delivery a nmawpmrr armanon.
wine Number /I}
Cuban"Name; P'MV Cm
Morass 21 Quaker Ransil, Dueensbury, NY 12800 pie, (518) 7461
CREMAMN 18 AN IRRE EMB E ANO FINAL PROCM.
Carol is um out by pherG the remainsminedemand also the cmdimr holding the remains into a areme0on memNr sMHe
tlby are aubieded orange"least and name. They Mal and name will incinerate and ransol fearylring ex eat Wm end ml
which am an Met will tea Ian after Cemater,
Following motor anon, the aemmon"it eke remorable efforts M reserve au of remains add other mail Form tie Crowded
chamE r.but some minima dust also residue vnll likely be left behind. The crematory will mpmale inordental and Mouth MMMI near
Me remains and theireicenm and human mabna Mu tea diymsed of asrequired by law The cremated remains wiu be lamely
pulimmadimo amen pbtp and Placed imo a neutral MnNirerorum. CMMe maim"mmllyampulmdmdueelno
singe fragment Is A<rgnlnble as SMIGNl hidden
OPENING OF THE CONTAINER
The crematory,may only omen due aontairer holdina tM uncremated human remains in limited circumstances, your she to confium Ne
idea of Me bemased OF to ensure tram no matenal is anclosed Mukh might injure employes or damage I Cmma puoceM IF
human mmo,ne are dmive red an a aorta leer wTlah m not emir We far cx "00 Such As mmmonlal or re lusket8le
rcnaWry Nil add ire that Me emeins he mond into a suitable Consumer Were NacupM1 8e remains. The centre Of
bananas or Me transfer or removal of around NII be mMu before avideu and atilt Ge done in pnnq, Mh dignity anal Baal
IDENTIFICATION OF OEOEABED
Name of Dendaed. Dorothy Rohn ill status wdmM
Last Nnawn AM 1331ewrenu Street Saralya Spurys,W 12893
Plain of Droth w¢by Health Care Center
My, Ow OP age: 72 CDR. 06/20/1948 wtemomth DvIo o EWmAhdw ht. 210
oemlrMu of uyteY finer in all remain Mil be denrered.
Cardboard Box wMlooden Base / Floatage al
PERSM IN CONTROL OFOSPOSRON
gWmn(a)er�holddlspo n, In a)ONEOIfMMWntirq)
mNJa am the desA,g agent of Me demeaed designated In a At or w n'mNu nt enarad puauan C Poll
Had" rave B 0201.
OIF' IAl have no knowledge that the demo¢Mena a minen InaWmml Wrman to Pudk Health Law Section 4201 or
n carbon g direNons for Ire dbpwtion of he or her remains also I/we are Ire permed MNng pinny,under Fubll Health Law
Section02% aMhaw Me Nbttoauthor crem4mof Meremainsotlhedemand. Myl reia8onahipwthedemas"bas
follows
Dorothy Reiter
DOS.1e93JIRev. Mil Page 1 of
Authorization for Cremation and Disposition
(fmm non es 0d sewn
NumOer.5 oeeugtion'. Lee Ruro(mughter)
1. A person designated In wool Resume to Public Hart Lew Secfwl 4201m),
2. 1Ta hurrying theme.
m. led sunWmg eomnnc paper
x Any suMwmg Mild model yams M age or older
A AsurvlWng parent)
5. AsurvlWl cutletue eighteen yeeo of We or clear
G. AIBwNlly appointed Monsoon'.
y. Any pesonts)egnteen pays of age or older amtkd of sham In Pe estate also who moan doses)in Maoom or to the coasaeer
shows othe estate
S. Atlose Mentor house"a me mounted a wagon 9bbment pursuant m Pi Haven Lou Reagan I201(i)',
10. AMef foal officer of a aunty or a pudic occasional seasonal prompt A Em Bunoyte's Court Procedure Act
late A"later Wm wn is eGl on oehaff Cl Me deceased and who"aarrested avmass steamed Rawmt as Public HemM
tuff,System @011D
m aLL THREE tend rowaval
IMb nearby affirm that Ms body of to discussed eras ter mnum a battery battery pmtla power call ra]imGve Meant
or Mioulw aevwz.N Mal anrautlimffinamwxe removed pram Ne e.muon Wtni.AUlhoeY.Oon form. f.MUNbrvmaw
Mesa Iamm prm.mcnmWon m.v muldn name mMe nremamn ens rnmemn panongl.
Page alum thatomWGom hue been own to Rollandwncw. rwwg
regarding the mmovel of any Wmcnel Grey,or err Ming ofvalua what am Lemon moral bwow or my family panel of 0e
de ai"Mars m pave Pine VF Csmai
w
m ndreappneaa roeme remo+alwpereoaHtemmlmm Me wnmlamafmm Me remain dine e.maaed. Pwreon.I x.mslertm Me
Mice or your .XM1 M remains will ba roya by awid Me emmaeon onus and"mount be mbavea after cmmaWn.
f hemWau%odze Pare Vlaw Cmmelary
survey won
to cmmab"nmeim M Ma eecomed.
Io CPTONALI
May herb a uuoem the named Hall appear to Phil for"lv*i or and namvUm by an alumni
pMrt .H Moral mceyary In Ma opinion of Me funeral do recror,and m amend this Henn m provide No comet name and
address of such alternate cy ateR.
FINAL M MSITIOH
The pmmn authorized or easier tM cremated remains of tlw MmaM once the uanemryl0:
Noma Corpassamm Funeml Care
foN¢l M2 Mepd Awe., U4 a5pM0e NY 12W Pnas. (51glopidBM
They ma remains of Ceased will be depmvad of as follow,
RETURN TO THE FAMILY
If her may re they Lenin named eWre deaf ng tlm pweawan d on ice mm M
Pone Ww Carol anaMx®d to gavem wof
acreweyw.0
they min CM Todd Fu Can, In y.dy'nyay
on Rrwn or by ng"m mm'll. R=as'w++wa 0.vMy Heiser
wseems
005180auf(Rew. 0V20) w Pool
Authorisation for Cremation and OispmUffin
(iMrowewn
Mail emotional lnN It the rcmama are not owned mlNn IM days of consistent,
Pone view cmmatory maY0lMaeeMMalYlrYm in
an vreNavaek mentor, soon be W scaltennif rtu,rc°rc�wvw
SHEMATION CONTAINEWRN
(begal ONE done hadm J
M um W Me used as a consiier Or tly ooxred Patent Ism been puMw Masi
and is assorted as Wltwrs:
III unseal um if Me an is twunwl W Mq Na enePa vesieead retains an addi dpid WnuiM may W used Onandyry
oR-
Mum6MtyNpualvat%. IMEundea�dsinumumgpuMa «omen'nsepropdad
Plrevle.eremaWn an place me memated amalnsIn
a JIa hmponry cotters he deNay Xrauwaw®n
This Antidotal Form was pmuWM by RaIand G. Hoy "a meculedM
h Compaysionste Funeral Can, Inc
J 2 Maple Ave., SyalOpe Bgiys, NY 12M
�aaaniaai
and is stands by Me tumal dinner as attend to its weacuson
le M'R recaivl a Centel copy of Nb AUMaHi9bn Form.
The parmays)Identified Mbw Wan Ma pemorNq In control of dYposMon,"a by signing Mb AuMwtaaUon Faro,national
W Me accu my and cwnpkbnme of Me Informationcorhlned In Mist AssMrlptlm Famr and Mandho fal Me bnaoing.
gained Mls 11th ad, Auamt . m M
IIY Rub e'
0 Gmmn Road, Bool NY 120
Season
rvarvm ,i apse,
WITNESS: v q
RollaM G. Hoag
ra 115M veaommnw,m ywN
v pyoµy Feel
Dci 1i gd lNev. adi Patel