Fleming, Walter (2) /////----------���II DeperMxrlelsY4
�AITOJY Division of orvxeox KCEMETgRI6
STPTEOF NOFo M"eRile
D"DITUMN) Cemeteries thin w�;
(du4Ma22a
Authorization for Cremation and Disposition
This PVenteui n Form must be ComPN and signed prior to deliery,of wmelns fwcramatlon.
Data 0&1012020 xunf: l��l
Crwnalory Nam:PlNe YMIW Qremationga l
Address.51 Quaker R d Quesereli NY 12804 Phma: (518) 74544]1
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
G mMon Is named we by pmtina ule remains acne aeMesN add the comes,holding Me wou ins Into a�chamber dwwMNrMne
Mi are sWiecm me d to intense teat and Na . TM heat and Same will lmlmram and consume s "in boat are match.
ANSI am an that will the left amCremation.
FoAcwmg Cmmetlm, the g nkdNowill take masonam BXOM to remouB all aMe remains and other material Mat the aematm
Wmbec bNsomeminimalduetandmidue MIIlikelybeleftbeh,W That udMkIt ill separate Incidental and foreign mamN1 hpn
MB Tmaim and Me Intiddi and foreign material will W claimed Of at rmulretl by law. Tile Cremated remains will by metlunrJly
puhwn2 ,=s"lpe aMpla that adawgnamdW iinvwum. Drememd im""n llyampulvedaedum no
sami napmem Is mWnnabx as 2Mat lCum.
CONTAINERMENING OF WE
TM uemamry may only omn the cont
emner rid un�re ding the max ma d human reins in Binned Nrcumamnces.such eye to xnhm the
ident"gre damesad se ensure that no material is enaoi wiM might infureemployaes or damage Me doo ry pgMy. N
human mm im am delMx In a container which Is not suitable mmnmamn such as Ceremonial w NMI caskei the
amry wIII rmmre MettM mmaln.ba moved mm..anebla wM,Imr ONam n.uspm th.r.malns. TM opening ae
wMamerortMnaii or remove of remains will be mndudN beers a*Mau add and the demean Nosey MM digntrand mind.
DEITT F CATION DF DECEASED
Nam Of rise Weller FlBTNy Mami Smms: Widowed
Lad Rmwn Addresa;23 Woedl dP iM1 Queansbury NY 12B06
Pero a Daniel 23 Woodland Nth, Queensbury, NY 1280M1
Sea ® M nF Age W DOB; 0&02I1854 pax aDMM1: 0&OW2020 Esumemd WagM'. 120
Disagdon of uakWcoMaina in much mmains will W de4we].
MalMew'a Casket Co. Wesley 55 CI0111 CDVemd PaddO Wood Casket - Crepe Irltelklr
Fr D TR DMPOBIrIox
(Porm'I(s)el mvnol d depaelbin.�ONE di Me fdkwvg)
Iwhi am Me dulgnexd agent of the deaeud dug in a and w'aMxninxrummd emou]Wrganl m"i
J
4201.
Ve
nokmwmdgeMeNedeceasedeu tedawntlenia mMpu ntaPublicHeaMlawSection4Nlera
dcoldi 0b M for enged sp anof hxatonr teremap Owe are Me mrtoMstMuilgin nshipWy under Pmlic Heslth Law
62ota veMenemwamhonucremamnaMeremainsatudauesM. MYroarmlNbn.nlprotormc.a.admu
:
Walter Flemitg
DOS-188&f(Rev.W/!0) Paget W3
. Authorization for Cramatlon and Disposition
hang Me ftfbed")
Number: 3 ramarriew(C3fildindin J21Waltnr Fleming, son, Ch Fidel ftlear. daughter
1. A"me designated in virixrn Manua to Pudic NealM Lew SeNcn I201(3):
2. TLe awiing sawde,
N. me sYmivire dowhimc person
3. Any samamg child eighteen years a age or under
a. AWMWp Perot
a. A dual sliblud eghleen yeas of age of alas;
S. A mentally appointed guakian;
T. Airy persm(s)egal years of age or olderentNedi to ahem in me row died vino ✓es Panama in mlancnehip M Me a.weed
r. A duly ampWimm fiduciary or the Sunni,
P. A arms roan or MiMiee who has seemWe a Often sutamem Pursuant W Public Health Law section 4201(7).
10. A bir hull dfimr of a mars,or a Well administraterelabrae pmeuem to than Subvi 6 C Udt Pmmaum AG:
10a._ Wrmn On is ecaing on behalf W Me decreased am "a haz SelMed a waxen WmvMm purwam W room Main
/alom�
= OL
WMB(M'oatiglrelay rMrm Mrs the bury oftre asomman aoem Prot mnl:n ahansrv, omen read. W.er rail, raaioabrO iMeans
and that anysom maeradhOre remwm Pwrw Me exmubon atN$AaRorzSa From. sanumwmrela
to cRrr4eon myMYh In hamr to roe ctewul and nematary penonnal.
en Met beWNone have been given b Ca3�id VVieSBMna
vel awry nomeal aWerry or aherMIN ahwyOuch any permn sgnrer bamor"famlq mandi01Me
W pesave Pine View Crematorium
myrama Ml Me removal of personal hems kcal the maalrer or ham Me remair2 of Me damzwed_ Ponaul Rama N111n Ito
Ma rematre Oil ss dissected MMa cr on pr«ew an ! camel an MmM a mar cremauon.
Mmby MMwil Pine Vlew Crematorium
.a+ omes, lotmnaW tler ratWroatMaawaaat.
rhtuIOPT Ay
tow h.mber aothoame the named funeral aleroWr to prwtdielor aelway to and terminal by an arc.rmw
d a«m.e n.ana.an In W.opfuwn am.funml mercer.. and to amend thes wren to proalae tn.ccrera ssm..na
mawsasumaN mcmmawrn
FINAL DISPWIT ION
The Person andemayead to rMXa the=e mmein a Me,revealed from Ma Uamatmy lam.
Nall Walter Fleming
money 21 Waatlland Rath Oueensbury NY 12ff04 Pow:
1M vema2di ern a aemnm'ml M d'eposedi of as Millions:
ResaintrandW son,Water Flearrift far burial ' Pinfeather GSyygygyl Quagraingletai NY
xWaw mambo Me paw IWmed move does netWill Ww atell aaoaWa ermmd,
Pine Yew Crematorium he aanamm be give possesrona
tham measure W Regan Danny Stafford Funeral He om by ael'ivery
P.�wx.ma.w
in Wrsmwbv WplaWmdi teak Welter Fleming m.sucss..a
DM 169"(Rev. ON20) PW203
'AudSorintion for Cremation and Disposition
tj�µma ra wN
�IN >uMmWNtlW HHw tamain ere M cannot wMln 120 mays IXammution,
Pine view crematmum mayd'spcseot Memamwsln
mw..ac..en
m be manner, eat
M astw ewaenng.
EMA a;ME R
t� often rolMwMg) Ragan Denny StafloniF
M mro0euse0 esa wnlal er rMe tegi elm. humane t+a teen Wrcnna�
a ie had as rolMwa:_ Va LOaI (IIJ�:V u+� W ✓S
MeeU tMaM Me nPe an a Moamen ro hold the enure tmnW samens.m scat,Hnrel Nit coMiner may be Mae Me temell
umm MyM putlusel vM urinsleM n�elnmum is pwNUMaNlervnx grovieee
I\ PI Y C Corium wil pence the cwraroe^n+me in
dossawd
a rpie mmpamry mntmnarroraxiwrv. pm.
This AuHmeaaHm Fam was prorAMI M Cassidy V nStteMna "a executed ad
R
meg Denny Slaflortl—
neral Fu Homo
0 Owker Rod Queensbury. W 12894
Ma sanest M Hro tmwal anzYor as*amss at Me mefulkn aewN
Me have re6hej a complaMe wm&has AUMOM Fmm.
Tie pemonlsl IMn1IMe Hebw lelase Me pomonml In cannot of empaaHlun�som am slnnlrp Men AUMOrlsatlm FOns.steams)
b the accu2Gy andCanplWnass or Me LHOmugan eanttlMH In Me AeMelcatlm seem aN eumenelsl the foregoing,
egme Mla A tom eayof qusl 20 20
(�n I�L�pyvtl,nm _
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sF �� (` � Fai tt Ny 12Po1
wexEsa: /0 ��
ca 'ay vorslaMna l�
p..-wa..a..n..w...w., I�w
3]09
wallet Flemirg
ppe3d9
pp8�18ga1(Rm.M/1n)
ENRON
Pine View Cemetery $ Crematorium
Quaker Read
Queensburyl NY 12804
(51 a) 745-4477 or (518) 745.4476
FUNERAL HOME: 2 yIZSNJIi.S� A.r/
v �C . RETURN TIME: �j 1-rsarC—. _..DATE S TIME REMAINS ARRIVED AT CREMATORY: _
NAME OF FUNERAL DIRECTOR OR REGRISTERED RE�NT DELIVERING
- I-- -. ncr5��/.�g_--
NAME: f.�'✓A�J�2_ ._4'
CASE 9
TYPE OF CONTAINER: Ajge jg
� �/ —�,ks�:._['m_J�ila�,y�cl htwcr�J_eEcixb lo-,r•!PLACE OF OEATH: .�-"YS�IK✓
ESTIMATED WEIGHT OF REMAINS B CONTAINER_ _
PLACEDIN HOLD:
PLACED IN REFRIGERATION: _
DATE OF CREMATION: f-2Pgp
TIME STARTED: —71&___
�TIME COMPLETED: L _
PLACED IN RETORT: _71Z _—._
RETORT # IN WHICH REMAINS WERE CREMATED: S y
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED
FROM TIME OF ACCEPTED DELIVERY: MOREE TNgry pS HOURS
k
NOTE: TEE CREMATION LOG SHALL BE RETAINED N THE PERMANENT FILE OF THE CREMATORY.