Loading...
Lewin Jr., John Henry Pine View Cemetery & Crematorium Quaker Road Queensbury, NY 12604 (576) 745-4477 or (576) 745.4476 FUNERAL HOME: Yy_� — - --_lHKEE __.._,_ ___ RETURN TIME: _ DATE & TIME REMAINS ARRIVED AT CREMATORY: NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS: NAME: TYPE OF CONTAINER: GCS PLACE OF DEATH: ESTIMATED WEIGHT OF REMAINS & CONTAINER_,� /solir / 2_6- rl PLACED IN HOLD: '�,L PLACED IN REFRIGERATION: _ DATE OF CREMATION: _ _ 8 Ito TIME STARTED: C9(�.I TIME COMPLETED: 3:3D Pm PLACED IN RETORT: Z o--¢JLMOVEO: 2 3'NPt1 RETORT 4IN WHICH REMAINS WERE CREMATED: DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN—GS—HO—UR& FROM TIME OF ACCEPTED DELIVERY: NOTE: THE CREMATION LOG SHALL BE RETAINED :N THE PERMANENT FILE OF THE CREMATORY. New Volk Saw —J NEWYORK Division of D'°""r"ma"N sTATEOF DIVISION OF CEMETERIES OF90RNNnY. Cemeteries en Ai TIrp re, man seaeAll NY i Authorization for Cremation and Disposition This IOWOnaebm Form muM W CompMee and aBnee Prior to delivery OI remains for cMmel Dale: gust 10, 20M Number II I Cri maary Name: FaAm Ulew Crematory Audrear.21 Quaker ROae Quarre ry, New York 128W pMM, 518-74 1! CREMPTNJN Ia AN IRREVERSIBLE AND F NAL PROCESS. Cremation Is carded oN by placing the deal a to ee¢axe and Me COMeiner holding the remains ii a v "on chandom e they are subjected to inknx heal and flame. The heal and flame w0 lneiMM and cowumee arompingeacepi bone and malty, Fa areal Mat the hitsremabr cnmafior. chamber aemorpre Meal dust ry and d ll rescue re&aoMNeyaftbete ndo aAaMe remains eMWeerdeeIMo MetlNM40n chamberbut acme muddendustantlreeHuewillhkeryM delealo Thecrematory MII bapeMeintltlerdal antl kreipi mateealhcm Me remainsand the intltles; a are foreign maeeal will bat ciapMdi a as rphann bylaw, TM vemel tremainsnsll a drug no all into amen serer are pared mend a designated¢plainer or um. CmnaW remains eeneMlly are pulwrrme nail no airgM M1vemanl IN recegniable an akaeNl n..w. OPENING OF THE CONTAINER The Crematory may only open the meal hading the accounted human remains in limited aramaament, mM as M confirm R4 itlennty ofthe Herself or to ensure than no mamal Is enclosed which might Injure employees or damage the Crewstory propeM- N human remalM am del famous In a caMelner which Is not suitable for cmnal such as cerebral or r lcasket,per medical will require Mat Me renal be as mail into a suitable coaainer pawn NaccpN the remains. The opening a e xntairar or Me transferor removal of remains wnl be conducted bekre a random and will be done In focal with all ntry and reaped. IDENTIFICATION OF OECEABED Name a Command John Henry Lewin Jr Maaal SMtue Memetl Last Known Atleme. 10 Havnantl Pw South Glens Falls, New York 10M PIeM of Death Glans Falls Hospital 1 W Park SI. Glens Falb, New York 12801 see: © M OF Age. 71 DOB. 11-28-1g48 Data of Dare:084E-2020 Estimated weight 150 Dayailder,acaskenc tamer in whchrmmaM cow be eeliuertd. Florence Casket, plywood corrugated cardboard container. MMM IN CONTRM OF MSPOSITION (P (a)am lyd an daposidoc, deal ONE of the Mora f enormous ere Me deelgnl spec a Me exceeded int igraletl In a will a sproen haWmare executed Wnuenl w Pubic I hLaw Setlim 4201. O Me have no knowerel the Me deCeandexCYl¢da"hen Instrument punuanl to Public Health t%N SeNon U01 me corers 'mg dhev9onsMMe dispodtim of his or her remains and May are the Normal laving priority under Public Health Lady Section 0201 and have Me righter authorze common of the remains 01 the renewed! W Our rea canMlpw theewe eesd d as raiders: John Henry Lewin Jr. DO&dgd fRev. Wrz% Page1a3 Authorization for Cremation and Disposition tr " �roroh;ngl Me undmbm MN Other remN are rwlclaimN within 120 days of uemabn, crematory wmnun may euWse of mremaM In an irt&rievabb manner. such as W e¢athanng. m+. f IS of to N wl j An um toMaeE aiacoMein¢rhow Me VamelW remains lNe been WrNa9ad horn M. fl GFnaf FUMrel Hgna and is reamed as Mines:Grenihmate Marde Urn IANe understand hurt if than on is too small to Wit Me el oamal¢d remaiM,an adernme fil mllalner may M Y9M for""says. -0R Anurn is nd yet gxNeeed. lMunderslndIMlifnGUMMNr orot "m pmvidW one Yrew Cremebry, wd clam the uemMM rmmalm in mwa¢ewH a tall temporary romirser ter delivery. The Auffim"Wn Farm wa8 Modest by cwm C. himi puwwosnrmwr was exesalM at M. B. Kill Forms Home IW Man Sl. Sam Glens l Now York 12803 rH.rv�nn. and is 4pnN by Me funeral dlrepor as svMteae to its still INJe Mve rereived a mmplend copy d this Abasement Farm. The parson($) Identified real al Met person(s) In control of disposition,wM by signal MIa AUManaabon Form, aflee11s1 he Me accural and romplsanass of tlN lnbrma rst contalnel in MIS AY atlM Fomr and a6(e)the foregoing. Signed Ma 10 day of August 20 JoAnne Granlm 10 HavilaMAve Bouts Glens Falls, N¢w Ywk 12803 "TOM: Claire c. Korcge 11932� cow^ John Hwry IeMn Jr nywwevrss pl 3d9 DOS 899-1(0.ev. 11Crz0) Authorization for Cremation and Disposition Numbar.r usmwow) rvumbc 2� Description: meaumvmg spouse 1. A narecn dracerated in wmrg Normal to Puwm Keaw Law Samon 4210113E 2. The surciuinp spousal L. This Royal dumeatk parman d. My saymnt coil eighteen years of ape of older, 4. AsuMmng Parent S. Am oral slwmg antitrust years or age or olden S. A mwruur appointee guadon; T. My persomm approach years of age or older entitled a aharew he mate and who iswor doaeann elation:nip to Me aedamaed; S. A duly appointed Salomon of Me elm: g. A dose Mend or whom who has eaeated a women statement [ursuent to Pablic ravel, Law Sol42011/jl 10. A chin fiscal ofRwr of a county or a public administrator apointed rynuem to the Sumbide's Coun Prommere Act; us. My MI person who is xOng on behalf Of M derened and who has azxNed a wdllen aUlanent pursuant to Public Heats Lax S anion 4201(7). (Iry THREE of Hre lwyouLg) IMb hereby atfim them Me body of the deceased does not contain a ba0ery, battery Pack, power ull, nevermore Implant, w MIIwgNB drvin eM mhelmry sash maledW wH¢remaaed prirrbMe YB016rn INtMS AUMrriaeiirn FOII11. Follom Wr ove m epriorto mma0 may Healt In tam to me crematory and crematory pemonnel. affirm Mat Imperial have been given to Claire C. Konfrow Mmg the remrival of any personal proppe y or other thing of value which any person signie below or any tamely member M the veaeaed wishes to preserve. P1m Newaememory is nW reaponsiblelrr Ne removal al perwnal ileme hum Me coldainarahan the remems of Me deceased. Ponoral ibma IeR In Me Wilmdi �wlMMere wmmllWMMyodby MecmmAonpmmssandunnotbre Wre akereremation. �y�li brainaumorne Pine Vex Continuum12 r Uemmaw me remalm of the M[BeMd. Qatar OPTIONAL) Nee hereby, mandate the named funeral director to provide for delivery to and cremation by an advocate slap It MemM neueeary in Me opinion rf the funrral i iwcbG and w amend this tam to provide ne Cprect name and address of such abnormal crematory. FINAL DISPOSITION The Person aNror'lzed to ormins the damaged remains of the chromium turn the oriental is'. Name: Pine Neer Cremekry Pddi 21 Quaker Road 0ueensbury. New rod 128M wham W746tl77 TM cm mwd remains of chemical will the disposed of ab Mlowa' If Ma"reason ne peram named above does not take We On Ntl1e aemawv mnena, Pie New Crematory is aumhur¢ed to give Possession of de wmynap M. S. Kpi Fumnl Home by del'"" wom In poem or by registered may. P John Henry Lsxin Jr a DOS-18 f(Rev. O O)8 Pepe 2 of