Eastwood, Anthony D. Pine View Cemetery $ Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: _
- - RETURN TIME:
DATE A TIME REMAINS ARRIVED AT CREMATORY: _ __
—
NAME OF FUNERAL DIRECTOR OR REGRISTEREO RESIDENT O"'VERR IH�O REMAINS:
NAME: _ _ _ Fn[�
_ .�v //� / tog-
ESTIMATED
TYPE OF CONTAINER: G<Dy.11l
11• ' as _
PLACE OF DEATH: �_._.6�,([FF,�`1_. /A�F WEIGHT OF REMAINS A CONTAINER__
PLACED IN HOLD: �—
PLACED IN REFRIGERATION: _ ItiW
DATE OF CREMATION: <T-jp -- --- --�—'-
TIME STARTED: . 7iv_ TIME COMPLETED: IPl
PLACED IN RETORT: 7 I _ p
...___MOVED: ' 1
RETORT 4IN WHICH REMAINS WERE CREMATED:
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN y0 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG $HALL HE RETAINED IN THE PERMANENT FILE OF THE devsiogv
N0 OppW
DrvtONOF C3MEmERIreS
ST
ITA1eDV v $ Dn0
0P1
Cemeteries .mzzAt'amm
Taw l,MIN<ari
Authorization for Cremation and Disposition
mis AVOmtla Form must be complb roe wend prior to diagram a remains for crxnWon.
Dam: DeNNmzo Numbw: jZ3
Cnmatwy Name'. more Weu Cnmerory
Mdr 21 Ouaker Rai Oueanabury,NY 12E04 Prome: (518) 745da77
CREMATION IS AN IRREVERSIBLE AND FINAL PR0CEN,
Cremation a comb Out b/gxtnp the mmeiay of me tleosaW vd the container Immune the mn m Imo a comwon N wmwm MxR
meyamsubg feminine MataMfame one beat and earM ad incimMe and consume everyMDp except bone and mural,
whkl insaubat Mllbememenae on.
Infamous mein aticn.the aememryt MII Mka reasonable efforts m remote all often remuna said thermal ham the cremaean
chamfer, outname Qnmwilllad Eebe Eehind. Theaememry unit Xgarem InCkeMN antl(pep"mWlel hqn
the remainsantlba Southernemsnd plominto roNlwalbe d l inedoran reeulreaMd meuanamil rempu wnlbe inlcYly
single aid Imo¢men µea«and emmb into a deslenmae mmnbmeroram. cmnatae Imam¢wremllr are pmlremw rrnub no
single ingment Is recopniaable as ekeleml Weue.
OPENING OF THE CONTAINER
The crematory may only again 1M anminer holding the uncremabtl human ramalm In Iw ital circumstances,such as to confirm Me
idenmy offer tlewaseo orb ensure MMno membel w ando9ed which might mum emplmyeaaordamage the crematory prcPol IF
human remains are dollwrae Ina ccnmbmr which is net SUM MIS for Cxmaeon Such as commerical or rental cai Me
wmaMm will require b a.tme"maim be mmveu In a sueabm monwlrrerwmra Baccepm the,amain. The opening de
malmr or me tanemrmr remi of mmaimwal Or wmudm Interco a wmmn shows m done In pi arm dreneyam respect
IDENTFiGTION OF DECEASED
Name of Mussed'. Armany D. Ean mahml 3mturs, Monied
Law Known Awnro: 10 NlYpyl Lane. Sareb2a So irgs, NY 12W
Plea of oeah: 10 Nilmr of Lane, Smem2e Synge, NY 12M
sex'. Om OF Agar Doe.7-S-/939 wmmoemn.. oen2rzo20 smn.ma weigd 19S
Cameroon of awebwubmer m,Bich remains fen be doitcred.
Cardboard Box wMagoden Base
PERSON IN CONTROL OF DISPOSITION
(W"Omo)M Lmbd damorm m. mail ONE dfee Mkufm0l
I amNA aim me dsignate0 agem doe dec¢ame ds¢ipiumd In atoll an A n in¢trumeM exewtee pumuam to Pudic
NUM Lax mobon0201.
AANY Moe no kmweedea nor than cecaa9pl yaWhd a wnMn Inomment puauant to Pudic Interim Lew SeNon Q01 or a
o wnuming dire don be Me damoral of he or Mremems and INre are me poi having monN under Profit Heath bare
Sedon Uol and have the north abmr¢euemabon oftle remauns ofine deroald *y rmlNonshipbibsfteSWNas
bllg
Anthony D. Eastwood
Well 0esuf(Rev. n1i Pagel of
Authorization for Cremation and Disposition
Numbed
(Insert Me poteW)
� OuvrypOrt Judith EdWawro](Spaure)
1. Aperson Eesgne in writing pursuant W PublictraM Lax SeWOn Il01(3);
2 The wrvNing seemsi
ga. TM sul domestic persona
a any Man,miy rnla canteen seen or age or Made.
A AMoral parent
a. Asu Wing aiding Member years M age IX WMrI
g. A IaMWly yygingd guaNlan',
g. Any pone)someone year;of no 0r Older Message to stare IntM entre and r00iNre Closest in reuse My to sap damaub,
S. A duly appointed fiduchary of the came',
8. Ache mend or real mOr Me emcuktl a vmlmn sentiment bureuanl to Public NbaM Law Section 4201(7),
10. Achief Macy I ofimrOf a ocuMy Or a pudic administrator appointed resume to Ne Surmgale s Court Pmandure Red
use. ArrymM1Mr person Milli al on What of Ta messed and who has mans a wM@n annua l Wrsuenl to Pul NceM
lLOW Sacm,a$Ot(T)
(Ice ' THREE WMe fi%Mng)
IAs a thereby arm tat W body of We defendant des not began a tea" salary back. Meer cal.radloative implars,
radimmve been and mat MY such mmenalaxgre remoed pwaNe cu MlMlsauMarfrsa(iOn Form. Failunroramoeb
range "me War cmnabon may fraud In harm to year uamatory and crematory "mmnel.
54—Mile affirm tat lnshuctima harry Often given to Rolland O. Hoag
eye imp the removal of any cerebral pOpMM or otlrer tang of value wNT any barren Hyping below or any form ay member of to
deposed wares,b novel Pro Vi CRat"
is not estimate forme remwal of personal items hem Me cantalmr wham me hill W the deceased. Pamonal turn. Ind In to
/Icontainer or with the cements M11 be deeboyrd by der wrongdoing be mn pro and Penney payment]after cmnation
7f,
NVa hemby auTome PiM grew
marnew,". ry
(L f-- u cnmau Me remains of Me dacaeaW.
hnMaIOPTICNAL)
CM hereby,returned to named umnl director t0 pr never far Monetary u and cremation by an animate
p mq,N chanted necessary In We opinion a Me unenl dlmWr,and he amand Mu Name to prwim Me comp nnm a no
adOmae of such abmau cremal
FRUL 018PMITION
The person Mail Wm0 alw 08 entered remainµ of Ny,deceased hem me cartel in
Name. COmpvaonM FW&el Care
Andes. end Mal AW., Samuel Spiiga, Ns 12866 phone MiNdea<Ma
The ognabd faceted of dame»]AN be dµpesed of m Weary
RMAN TO FAMI Ls
If he any pool b6 Pemwi named abme mom m1 Yke cmeaslvl W to amended mmams,
Miller vex dental o lWlgiaod to pbe peeHwlom of
l mW, mrnfµv
to m rwna Cmrgak Fur Cone, lrc py daliaery
in person a by magnitude mall. d«timm Model O. Emu
DOS-1 SRI(Rev. 04,20) Am+ Page W]
Plies
Authorization for Cremation and DIMi)Oaltion
(MOO ma AdkMwt
IM4 uMmadM that gene r&nairm are not passed wllnm 120 days of cremation.
In"Van,Cremaom mey handmaidens manaiM 1p
en lm4evedle mTmer.such as by SOYadng ncemm
OEMg OXCOXTANE Uplufl
(UagIGMEdMe tdbrvgl
An um to to usm ae a Renshaw for To command rename has mean purchased M1MI
and Is deeproae asRNI.
Wq understand Mm Ifday un laba mail MW M6 entire Remade] whose an seaman reed mMamer may as mass for Memory
((((((.���oR��'.Jaw
#-MuMEWMPcrchaeee. Wbmndearand MOlfmumapurNaaedoromemseprwldM
PImY Dremadd
ry wyl Plaw the aW handed In
a net w hylat CmltinerM ealwry.
The AlMwfaatl Form was pmwbd by Rolland G. Hall wee¢xemXeJ at
compeuionew Formed cam l xau
4M Mepk Ave., Sararya Sismaiw NY IM
and leslem my Mefuneral Nredorasw wWMexmAon
iMh have renewed a mmpleded copy of the Autumnal Form.
The par lsl hunted below derare has formal I In wMral of dlapal who my afandna this RNhoNatlm Form,met
toMe accuracy end onomaanoia of Me Ioromral mnmdMd In has Ault atl Fomr and auMorWlg Me!ongoing.
Sgned this I311-1 add Augur on MTT Judd,E. Estimated
IO HIIICRet fare. Sambp95pdryq NY 12393 �c
mi
v anrorxw ylcnq /� /�
WITNESS: vrc,wmw gg4 (/ i /rl
Rolland G. Hmg
e 11838 rr
rmimwai
AnMo"O. Eastwood!
DOS 18861(Rev. OMIDI lisel 3