Rendace, William A. Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4475
FUNERAL HOME: __—_ Ar Xp,,Vt2 _ _ _ RETURN TIME: __
DATE S TIME REMAINS ARRIVED AT CREMATORY:
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS;
-- _ — JOP����rAyy��sga�-----
NAME: _.. VKCYhH _• tenF —_ ,_—
CCC CASEp �J�,
TYPE OF CONTAINER: II NM PLACE OF DEATH: ._�_�M_ _ �� �.1.:_ 17SN
ESTIMATED WEIGHT OF REMAINS S CONTAINER___ 14��,.
PLACED IN HOLD: �s
PLACED IN REFRIGERATION: —
DATE OF CREMATION:TIME STARTED:
� _�—?O _TIME COMPLETED:
IN PLACED
IN RETORT: _7. ��L�W_— —'
RETORT IN WHICH REMAINS WERE CREMATED: ___ Ruµ, f6K¢ I Y^11
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY:
E cBEmgiOxv.
NOTE; THE CREMATION LOG SMALL BE RETAINED IN THE FeRMANENT FILE OF Tx
e wk Soto
Department a
NEW YORK I DIVISIOn Of DIVIFION OF CEMETERIES
STA EOE One Cammna Pbxe
OPPORTONItt. Cemeteries 9pweaNnpwn Pvenue
Story,Wp23i
Toward''.Sell
wxx.WcnY9mv
Authorization for Cremation and Disposition
Thai Acxrm mWn Fond must be completed and slanO pnorm delivers at remains far cremation.
goes: OWIM020 Number lit
Lmmamry Name: Pine View CMMatOry
Mdmas: 21 Quaker Rd., Quessignsdaphy, NY 128114 Flmne.
CRE nON M AN IRREVERSIBLE AHD FINAL PROCESS.
Cremation is Gnb1 oN by placrp the remains of PB tlewui and IM xnWner Muting Me remains Into a cremadm .Ilnnber Nltem
May now deduced to intense Met and flame. The heal and Wme will IncIMMW and wartime ewMhlrq ma bores and 1,
which am all Mat wil I he lM other cremation.
Fdbwing cremation, Me company will too reasonable effol remove all Of the remains and other material from Me cremation
chamber, but some minimal dust and residue will likelyM ka behind The cremalwy will Senators eM faregn malenal hem
her remain and the lmNental and foreign MaWlal will to dupaed of as regulred by law. The cremded remains Sell be mechar lly
pulverized into small princes and placedInto a desgnated cobforer or um. CmmNd remains SMerally am pulverLL until not
single fragment be recognizable AS skeletal t W ua.
OPENING OF THE CONTAINER
The complaint army only Open the consumer hoped Me unco lim mated human remains In bed circumstances, such as to confirm the
Nentryof the de sed or measure Mat no maternalA encbeed which mighl'mlure employees or damage the cmmmmy prppeM If
human remains are delmr Ina terminal which S net suitable far mmatiom Such as ceremonial Or reward caske ,W
mrtory,will require that Me mdlab6 be moved Into a suitable container More B accepts Me remains. The c admind M a
container arms hanakror removal Of remains are be conducted before a worries and well M done In pnvecy, with dignify and respect
IMNnF$MTION OF CASED
Name of Dewamd. Wiliam A. Rendace Mental Sawa: Marred
Led Knosn Address 11 Aviator Lane, Bolton Landing NY 12814
Full of Meth: Dece8sed8 Reskence. 11 AWrtor Lane Bolters Landing, NY 12814
Bea: ® M ❑ F Age'. ]g DOB: 05124/1941 gas of Beath: !=)72020 EWm weghl 175
CescnpMn M Mkawm iner In"I mmaine sell ass delivered.
New England Cremation deluxe tiara ner
RSON N CONTROL OF DERWITION
(Permnfs) rn mnlM ddw(rrumm, and ONE(sti VMV)
I&rvWe are Me deaignted agent of the demand designated in a will or wMlen instrument proposed Wmwnt to Pudic
HWh law Sudden 4201.
n�
�.,
a have no knowledge Mat the deceased esewtem a wntlen instrument moment to Public teach Lew Sudden 4201 or
our Maiming diredlms la Me deposition of his or her remains and Mae ere Me pweMp)having pnoi under Public Reach Law
Section 4201 and have the right IO authorize cremation 0 Me mmelhe of Me deceased. WOur relationship to the deceased IS
follows
Wldam A. Rendace
DOS-1890-f(Rev. tourist Pape t of
Authorization for Cremation and Disposition
(mart horn No Not dwoe)
Number 2 Deecnption:Surviving Spowers
1. A person rkegreteE In wntirg pursuant to Public Heena lax Sep'm 4201(3):
2. M sureving spouse)
2e. The evil0om be paMer:
3. Amu nknago child eighteen years of age or dater',
l Awrcan9 parent.
5. A surviving sibling eighteen years of age or older:
6. A lawfully appointed guarder
T. Any Person(s)eiableen years OF age or older mtAW to Snare In the estate eM who lsare c M,n miMimenip to MedecNHd:
S. A duly appointed fiduuary of Me Succe.
B. A close(need W relative who has exe da alinen Statement pumant to Pudic HwBn taw Section 4201(7):
10. AchiMMen Never Of 0 Wunry or a Pudic administabOr appointed pursuant to the Surmgate's Coud Pr UM Ad:
t0e. Any seem n who is acing On behalf of the dewamd and who has executed a wnMn statement pumuard lO Public Health
Law Section 4201(1)
degaidALL THREE of the fam inpf
�Vwe hereby affirm that Me body of this dS aced does not Cape a bB"W Wtkry Pelt. Power Call. Mlmd'we implmd,
or mdoadive tleviw and that any such materiels were removed Nor So Me execut of this AWhw "N Fare Failurebmmow
�tthese Items prim to cramatlon may Name in Items b Me mmamry and crematory personnel.
true affirm thatinsmuGlions love been given to Dann itldAleannder
—rega^Nriigg Me remwal of any Personal prcperty or dher tine W value shot any Camon slgrri cam or any family member ofMe
deased wishes m Preserve. P' Vi Crematio
dy
u not r N%lae for the removal of personal Items tram Me wMainer or Men ee remains Mine deceased. Persmu) hems IM In tln
Na
med her or with MB named a$will W destroyed byd a ammmon procass and canna be retrieved efbr c rema0on.
\ a hereby Mode Pine View Crerrato
to cre wtlw mmeW Of the dace®ad.
(Initial OPTICAND)
gave hereby auOob the named Nnenl dwctor Lo pravide for delivery to and cr tlon by an alhmate
nmxt if deemed necessary In the opinion Of Me funeral director and m amend this)arm to provide the wmet name ant
eddraa of such alternate cumamry.
FINAL DISPOSITION
The Pm Nodzed to metal the uemakd remains M Me demand from the vematmy Is
Name:Alexander-Baker Fun real Home, David Alexander
Address: 380E Main StreM, Warrensburg, NY 12885 Phone: (518) 823-2085
The mrem remains of dem will IN d'oposed M as fdlowe.
Shipped to Cidieffirtaffif fill Cometery
If for any reason Me Person named above does not take Commission Of the ve WremaiM.
Pine View Crematory aautlm to glee paasdon Of
the remains to Alexander-Baker Funefal Home by eeliary
Per nove.
In Perron or by registered mml. xxw Wiliam A. Rentlece
DOS-1890.1(Rev. IH(10) nuv Pape 2 MD
Authorization for Cremation and Disposition
dabi the MwwvgJ
'111 Was uMeratand that RMe remains are na blamed wghin 120 days of manager.
Pine Vista,Crematory may dispose of me remains in
aw.gf
an nmhlemlee manner, wch as by satadng.
CRENATgN COWAINERNRN
(Ibmi ONE&Me ropomingJ
��^��^������ ������ //////������ Alexander-Baker Funeral
um W Oe used az a rmlainN IOr the amended remains has been puMVaed from
am is described as mines. M K Um uR-Navy
More assessment that If the um le too small to hop the sent eRmaW Mm nar an broterel ryld mnWner may be uwd for defrvery.
-OR-
Mumis not yatpurchased. IN/e untlantaN NN if no um as Marshall or abandon providel
Pine View Channel erg plaW the damaged remains'm
wswf�
a Wid tempo wate
rer iner for tlalivery.
The Authorization Form was provided ly Uaykl dissembler was executed m
Alexander-Baker Funeral Home
3WS Main StressidVoWni NY 12W5
and is Warner by the wneml direcNr as witless Ib examine
Were have rexrved a wmPlated copy of sea AaMornatlan prime
The demands) idaMned below Wan the parl in control M diapsalnon,Who by signing this Apolarizaum Farm.Moment
W the accuracy and complaisant;0the Mhormadan contain in this AU sombegoe Form and sNhadrote)Me forapoing.
Signed this i t days August ,20 20
Maureen A. Rendace sy 'i'y�_ �E
mwr.m ....
it Ana Lame, Botto Landing NY 12at4 —
WITNESS:
Efavid Alexander
1003d ,�.a�x..l W
WOkam A. Re ddace
Saw+o.�m
DOS-1890-f(Rea. 04QM) P"3d3