Smith, Julia Paige Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745.4476
FUNERAL HOME: ____
'L g--`4 - RETURN
DATE & TIME REMAINS ARRIVED AT CREMATORY;
NAME OF FUNERAL DIRECTOR OR REGRISTEREO RESIDENT DELIVERING RE
MAJNS-
NAME: _ ._. _ __ A _01t
'9--- _CAEFp
TYPE OF CONTAINER: __. ADQLorp RFN.pt
PLACE OF OERTH: SS H EDi/
-------------
ESTIMATED WEIGHT OF REMAINS & CONTAINER_ J�O
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION;
TIME STARTED: _ I0:0 M TIME COMPLETED:
PLACED IN RETORT: _ b:&D /4;pT
RETORT p IN WHICH REMAINS WERE CREMATED: � ��- /' I"
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN VU HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE:the CREMATION LOG SHALL BE RETAINED IN THE PERMANENT VILE OF THE CREMATORY.
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5181471
Authorization for Cremation and Disposition
This AaMOAaatlon Form must Ou canPMbO and eteral Prior in 4e11wry M nrmins M cr on.
Date. 08112/2020 Number lit
crematory Name.Pine View Do matdnum
A4dreM:51 Quaker Fil Quaenabury, NY 128N Photo: (518) 745-0477
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremation d out by oleurs me remains cea a or the eesetl a m end the nra holding m mm e remains into a cartel aem Arms
they eresue nagGedme tO lmen.e neat sere name. TM Mat and Mmewin seasonal all consumeevery g trcepl Wre aM human,
wish am an gut AM M AN mMr cmnanon.
FallWnngmanstbq the cRmMOry will hike nownsalte eflMe t0 rem0s ell Ot the real and other melenal Rom the aemmer
UwnMr, but some minimal mind and re¢Nuawill hill M IM behind. Theuemak willSenninddeMlendtmgnma Wheat
I mmeinsendi inudenhilend Mm,gnmenotmillMdlspa 1Mosr iiretl iaw. TM crtmane remaln¢willMmedenkJNy
pulvemee Into smell pieusaM pl ndme a designated cartel we CranrtladmnslmpananllyammNMaedundim
Nrpb Segment is recoohmble are skeleal tissue.
OPENING OF THE CONTAINER
The monetary may only cpen the consumer holding me unaremate] human remains In IimMd circumvented, Such as to wnfirm IM
human remains a we Signal In a co Ylm ewhkM1l noteutabl for cmmMion Smith ascenmonW are renal casing tle R
r ,nerywillrtra orlmo lofmincooedIMomaudWaonalmrChoreilsedon ihanvwymTMnAmidcte
COMeineror 1M Leman Or nmorel olremeina will ba COMVCad CBtoR a wMess aM will ere Bone in onvxy, with dgmry and negq.
IDENTIFICATION OF MCID SEO
Name M Denea¢ed: Julia Paige SmiN1 Mamal saNm: Never Merced
tap Nnovm Addrem:25 Orchard Drive, Quwnsbury, NY 128
Pew a DMm:25 Orchard Ornre. Ommsbury. NY 12804 �1y�
Say, OM IMF Ap; 22 DDB: 08109/1998 wa MDeam, 0&1=020 FaMrlaa4vn4 aVY%
Cesapeon olamMtlmldeimrin wnipi rerraig¢wtli MIMM.
nK1 �au� one -1e � f� A2n
PERSON IN CONTROL OF DISPOSITION
yywmA tan In wMM o(dsp sitm, in"ONE&the 1OR wby
ameNa are Me dmignpea agent Mine decee Edesignated mawill or whan 'wwnnal crecNM purwant to Puam
Hall law Seem 4201.
IM/e have no kncwleb]e that the de¢aed examined a wnnm Instrument punuam to Pubi'C design Law satlim 4201 Ora
will conning directory far the deposition M his or her emans and M are the peraoild Intent phony urger PUNIC N VLaw
Secllon4201aMhaveme Nhttoauth Gemalpn Olmeremains Mmedtt d WOMreatlonshptO"dMemdMm
follower
Julia Paige Smith
Ann
DOS4898-1(Rev. 0 rz0) Pace1M]
Authorization for Cremation and Disposition
fdrrtaom fMuuaWwl
Number: 4 oexnpnon: Parent
1. A person aeeignalea In wrong remained To Palk Thai taw Setlon 4201(]t;
z The surviving smase;
U. Tbe salving domestic nmrer'.
a. My samving child eghden years mthe or Mar,
a Asannowparmr.
s. Aaprvweg abllrg egmeen yews mega an mar.
8. Al awfully anointed Madan;
]. My persmn(5i ey dean years of tan or Mar erdtled Is Share in the mtb Fk who away tlosest In m1monsMp to the discovered
8. A Mly approll Tummy M Me peek;
D. ACMve friend or Paul who halt eawrW a wnten tlal M pursuant m Phil Health Law Sem'an Qotpy,
10. A chief fiaem officer m a wury or a Public administrator inpd purmad To Me embassy Court Procedure Ate;
10n. My other person who is acting on bebaa 0 the deceased ant who has amount a vmRn sdlemeM pursuant m Public Heats
Law section 4201p)
( 1(ryjl'@LIALL THREEWMe lOXpwugf
" Arm hereby Wpm that Me baby of The araYN does not Wraain a battery. betlery pactt. power call, radical Implant
wrW'pechis device and that any such matenalswere removed pLNb Vq special MtMa An a✓On Farm Feilmsmremora
Uxa name prior as arema0a n may muk in Mrm 10 May wemml and camel personal
kMe am=Mat inmorkine have been prvenro Wendy MM..Mlich
booming Me removal of any pmrhee propel an Mar Mire malm wdcn am Person p intng ewer an any kmip member of the
mce.aiea times k moral Pine View Crematorium
is ml informal W the mnwtl W personal Mma from IN consumer of from ag become "" decial Personal Items Its In the
Manuel or with Me nnWm sell beduhoyed by the cmra110n promise arm canal be retrieved after cremation.
�Me hereby supreme Pine View Crematorium
lo..o-.x.ml kuemakthe amlm wHa aerasm.
1(rrarel OPTIONAL)
lam hereby amhame the named funeral mreaorto pmvme for dsnvery as and co maum by an ammak
aremkry, N armed necessary In the opinion of the empirical cerebral,and k amend His farm to provide the com tit name area
ddress ref$well aftimm mumwory.
FIML 018POSTOH
That Porsun amhor¢ed to acaive Me uemmed amain of the decreased(ram tla c MM:q is:
Names.Regan Denny Stanford! Funeral Home
Address: 53 Quaker Road, Queatabury, NV 121104 pare; (518)7W-1114
The amended moon mbeored will be aaw.ea ref an happens:
Realm to family
NM am arm the panel abpr 1w not rib WaerM arthe me rwnwne,
Pine mew Crematorium aa~m kgse mrerknm
mwrwr.m
Me remains to Regan Denny Staaord Funeral Home by amkey
in reform or by Rives el mad. Julia Paige Smith
mm.am�m
COS-1 SM4 may. Ml Pent
Authorization for Cremation and Disposition
Ii new mmnw
Me unaNSMtNIMtlq remain.we nndbmW within 120 daysncrematen,
Pine Ylew Crematorium meyaapwe of in mn e nain
an inebbvabb mother, wT an by
Muca.ea
LREMATOM WWAINEM M
(&yww MEorMab mpf
An an to W and as a container Mpe vemNeE rtmaim has name puN aaab hcm
and b demand as tmian:
Me umentam that rt the um Y coo aman m hob the station conservative mans,an eml mid mntaii may be need for M+,
-OR-
�MunbrntyelgadbW. Wie unnnW tlgt MtwunepaMwq>otlbtWee govklM
Pine Yew Crematorium nee place the command oaths in
aw..ww.vd
a rgNt wmq container M Mivery.
ltis aaassinaad Form was prmeMd ny, Welly M. Bulioh was estimated al
uma�ro
Regan Oenrry S 1 "1 Funeral Home
53 Quaker Road, Dueensbury, W 12804
onwe�Adftm
and a Mooed by the hundred amended an Mu we b its exerubon.
Me have no ived a WMIOW ropy of thb AUMOIIaaaon Form.
TM persons)IdM W blow hon hue gnome) In Conroy or sbpwXbn,who by signing this Authorization Form,aM1Mtie)
to tam accuracy and conrpMbnNe W may Information canadnd In hub AWrMaarbn Fort and erMpbtiis)the f rise np.
edgnWthb 12M &ad August ,go 20 jJ
Kent S. Smith
25 Orchard Drive, pueetubury. NV 12R Miami
Awi
Welly M. Bulich
m—+owe.+n•e.a..e.w m.�+n.e
104/1
Julia Paige Sri
twwoa�e
W41ade1tRev. OV10) Phap 3