Pratt, Ramona Gertrude Pine View Cemetery & Crematorium
Quaker Road
queensbury, NY 12884
(518) 745-4477 Or (518) 745.4476
FUNERAL HOME:
..__-_..._.._. TIME: _/✓L
DATE B TIME REMAINS ARRIVED AT CREMATORY: /Q rl- -�.S
. _ Loe�
NAME OF FUNERAL DIRECTOR OR REGRISTQREo RESIDENT DELIVERING REMAINS;
Lks
FIRMS: -_[�RyjjnNA ._
CgSEp '� 9a� — /
TYPE OFCONTAINER:
:e
Y' ��
PLACE OF DEATH:
ESTIMATED W@IGHT OF REMAINS & CONTAINER_ ISU/ryS
PLACEO IN HOLD:
PLACED IN REFRIGERATION: �j;
DATE OF CREMATION: 4-
TIME STARTED: DD AYE COMPLETED,
PLACED
�,yF�p�q
PIgCED IN RETORT: _— ': _7 ft
MOVED: _— $.>p
RETORT pIN WHICH REMAINS WERE CREMATED:
Co rt L6
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 46 HOURS
FROM TIME OF ACCEPTED DELIVERY:
__.
NOTE: THE CREMATION LOG SHALL BE gerpmEo IN THE PERMANENT ALE OF THE [gempraar.
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Authorization for Cremation and Disposition
This AuNdtln Form mul mmtlaNtl end tlpned Fanatical olremalns bar cnmaaon.
Date.August 13,Debt Number 927
Crematory Name:Pine Yin'Cmmby
Andreas:210ual ROM, Denunciatory, W 12l Ph", 518h]45M7]
CREIMTIM Is AN IRREVERSNKE AND FINAL PROC .
CremeAcna tamed out by pladrg he remains of Ne 0 sM a no Me rorblmr mrst tfte iamaidihe a cmmellon member where
they am suLyetlM tourchs heat and Agree. The hutand name will Inchwreb and consume eB ing axwoWno and metal,
"for are all Mel will ba wit after cwmanoo.
Following cremation, M¢aemebry unit wive maeonede Nkr6 b remove all MMB remains and elhBr melenel hom Na C9netlon
chamber,bN some offer)dust and residue will fall w left behind. The gBmebry MII arprome Inddental aMfomign material from
the remains and Meiucleenul and benign"tenet wn Montreal of es requires by law. T mmm rsmaimwm Iremw anlwny
Movement into smal above and plats into a easignebd cartel or um. Cremated remains SenersM am gumd "ure rid
elnSlF fmgmsnt is mcNyMmz bw as$M lSuue.
DPEM NG OF THE CONTAINER
Fine vemmery may only wen Me customer hoairy M¢un<remi human remains in limited uwmsbnm sutli as to"fi m the
mi4ly of"dewasM or Io ensure May no marenN commit which might miur¢employees or damage the tlemttory Pmpem, n
human remains are delivered Ins cots finer whim Is iron solbma for ammanon such as uremonlal er Metal enkK um
Minatory will rpulm Nat the remain$be Moved into aeurable conwlwr Galan it accum Me innate. TheoPonmgcla
wnwinerbr Me anstar or inmost MremelnsvAll be wndudM hebra$witness and will be dine m prh'a%. with Ggnily And reswct
OEMFOAINM OF OECEASEO
Name of DecwMdr Ramona GBbWa Pmp Me Mal Stetue'.
Last Nelson PA hmays Sg3 bleat immune Rue,OueemWrY, W 12800
Place M Deed: Gwn Fate Respibl
sea'. Ore IMF Aa8:87 one' 7118/1933 wwaoeaM smtrm2D 6MnMM qu 150
OYGp6on a rmkellanmliwr'm Midi Mmeds"it be al'MM.
Minimum Cremation Casket, Florence Casket Co. Cardboardirl
PERSON N COMROL OF DISPOSITONI
(P.rsm(al in cC M a elspovdar memo ONE N Me Fckmir
I ynnYa are Sin designated seam of Me taM desgnW in a Nor m Yemen instrument es Pumuwt td Public
Fears Law Satlore 4201
ri -0 V-R- a
IAYe have no anool6lg¢Mattha dewsaed executed a MpM iummenl poste llo Puerto RUIN law saftia 01 orb
all examines directions an My coasts nn of his or her remains and me we the par )having priority under Pubi HUM Law
SUIwn ODOtaMbave Me KhtmauMoriID ationolthemme'me MMedeweeM. MyR)urreletlonshlpto Medaceawdl$ae
Mnm
Ramona Gertrude Pmtt
DOS-isS6f(Rev.arzo) radial
Authorlratlon for Cremation and Disposition
Nnwmmmmygabemw)
Xunmer3 Dommoon'. Any ouruMrp Eid egnpen yeen of pe or Older
I. ApRan Gesigneb]in wrier Wnua nl to Public War Lew Sec4M 4201(3),
]. me serving winem
b. The wmving doMHmC act
3. My wrvMip card eighteen yeah of age or noun,
/. Aserving parent
B. A Metal r lirg eighteen yeah of age or older.
S. A hall apWinW g unman:
L Arm perform)eirMmn ram of age Or older embed to Oman in her e[bb and onto Hoare dueest In Ma noo to ME
e. A duty demanded ficumery of me mole:
g. A cbm Mend or tell vi him executed a wntler,$ t eel amend W proof lc Healer law SxLan 4ot(7).
10. A clear Mend oTmr of a Money or a pudic amendment emalnbd pemued to me Switched Court PmR mAQ
Na. Any other person whole young on oenalf of the drounal all who"a emaW a wmtlen dtm naA mrsuand W county l M
Law Anchor 42DIV).
an i/al THREE of my Idbwing)
Y—Tk—INb Mrebr Mirm him Hoe bey of NO dm Goan red mmzm a bmery, ed0ery pyS,W^er m4 ndMecG.e vnp4nt.
crndioadim Levi¢aMNat any BUN mabnale vrem removed pmmW the emwbon of Mia AUNo a4 Fann. Fallunwmove
NmaI aprorOr[nmatlon may home in from of ere momentum and UMMMm pnonnel.
U_leer affirm met Insincere;have bean given W TOW G. IOlmar
nrenmeng The removal of any momml prapeM n other had W relic wMM any Wren ammo belmv cr eM Mmly m Wr NVa
Wham wishes W yeurve. Piro Vew Cnmebry
How
re nMrespon¢ibb err 0ie remwel of pmONel Hem¢han memnlelmrw kom Hoe remains Olera dexaeed Pononatlbme MRln Hoe
JalodnWinnerMw me mainswll be des aW oy me cmnUon pmcna and unnotoe reWal Mercrema0on.
y� �C mo Mnoyau odn phm Vmw Crematory mew
I W rnmab Me nmelm OF me deGuead.
(MMOOPRONAL)
mad Mnoy au homm me named fwomen dimmer W pnvlW for delivery W and Cneatlm W on aXemabi
MnMq,If deemed mammary, In me opinion of Yee fun l dlrwWrd a nd to emend MW form W prof me came amend and
OW of such a XemaM ONMMq,
MML DISPOSITION
Tne perm atuffacread Wo w the changWG reman M me dmm;ed from led aema ls:
Name: M.B.error Funeral Home
soma. V Broadway. Pon Edward NY 12M Prom: 516147-0r28
TM comment rmnelm W dewmd!AN M dlemmd OfSm WAvw¢:
BudY W Brand lakeG mm
Il am reewn to pion normal OWw Meets MM proormon Of the ae mum,
May vow Cmaory r aomaRed W rare pmsdmi0n of
r
day OBmamW M.B. Kynla Flmanl Home bydeliuery
in prima b/ryl Whin. p�mNamne GyrNge Pntl
oOStrgN(Nev.M20) �w Py Pof3
Authorization for Cremation and Disposition
fan(i�Io pMe/dbrpng)
IJ�a�"'�WJe uMsr M hand ifday rema'ms Ve nM tlaMeE vein 12D days Y Mma .
PIneY Cremelay mry ngaee MlMmnam in
ranmp
an im4iere0k manner,such as by enllerirg.
CREWTON CONTFNE0.NRR
l�cWhEwmermmwrinm
An An to be and w a coiner Jar Me oremattan mmama Iws saw%ans re]fran
and an dewed as faun:
law undenbnd that if Me um A We wan to hold MB BMn an barrel iwmay Me uM Waefry
-GR.
� W Mum u MyNWraia 1. IAYa unMnfdM NTllmum is WroMatlorotlnrvnse Provl]ed
pneY Cranalay will pleat thewarned remains in
Wmmw(Mr
a rmd temporary consumer W eastern
TTis Rullnrlaatlon Form was gm1dM by TpM G p1Mr vm Warman at
pee+uv-aw.0
M.B. I(Ilmer Fumnl Horne
82Bmunity, Ford EdweM, NY 12o3B p✓�resf
and is synard by the Nrreral dMMr an wihwaa bib eaewMn
LNH have remained Wmpleted copy of Mile PUMonzamn Form.
TM Wards) Malaysd Gabor blame May panonb)I in co brol of Opposition.two Ey signing this AUNaMeMon Form.erebbl
W Me mu My and commitment 0 Ors Information contained In ihte AUMMI w Form and 9uNorlaeb)the tangoing.
&gMd Mb NM dayof Aided 'yon
wan man
mark,
P.0Box 397.PGiiwgW, NY Verde �kT
eVIlf1E88:
Treat O. mb
�mrr.ewiwn eA^+
118]g
RemoM GabMa Retl
were, w;P-
NS10p611Rev'. C<20) Persel