Manos, Alina Angel Fine View Cemetery g Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (SIO) 745-4476
FUNERALHOME:
OEONE"
RETURN TIME
DATE B TIME REMAINS ARRIVED AT CREMATORY: - - - - -
NAME OF FUNERAL DIRECTOR OR ReGRISTEREO RESIDENT OELIVEgING REMAINS:
- --j/�iD___ F
DOD q)GMSGOft
NAME.
TYPE OF CONTAINER rl "-_CASEA �G
q�Ll✓__��SWr
PLACE OF OEATM
ESTIMATED WEIGF(T OF REMAINS S CONTAINER_.
PLACED IN HOLD: -
PLACED IN REFRI
CREATION: _ --
GATE OF CREMATION: +�—r+-.e"_/16�F�---
TIME STARTED: _ g_2c A ]� -
�. TIM E Co a eD:
PLACED IN RETORT: 4� -
I'Ir'PMOVED
__ gN, In 9mBn
RETORT NIN WHICH REMAINS WERE CREMATED; _
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED
FROM TIME OF ACCEPTED DELIVERY' MORE THAN 48 HOURS
NOTE.. THE CREMATION LOG SHALL BE
IN THE PERMANENT FILE or ixe <ReMnionr
Nev
Stake
Nmnt afySame
ME1Y ORK Division of DIVISION OF CEMETERIES
STArt05 mmeoapiaza
Cemeteries 99 „,, Awoke
♦eiro Nevnenlstartaki
Authorization for Cremation and Disposition
ThIs Auenonaabon Form moat sea cwnpmtm and signed Finite delivery of remains for creemation.
Oats: OYCMN20 Number: 19�
Crematory Name P,r mCmmatoman
nmma. 210uaker Read, OueensWry, NY 12004 pie, I5181TOSMTI
CREMAMN IS AN IRREVERSIBLE AND FINAL PROCEW
CmmWiw IS Umed Wl her(iaGngmar Wit or the deC Wand the moderate) ing lee remairu'ago a mme weather
that are subjected W intense Seat and Nme. The Met eve flelre Willlm Wand consume evN ing eagpt bore and metal
Which are all Into Wit M late aver ce flon.
Framing cremation, MeO¢melory WWII Mks reasonable eXOmto remove all of Me remain add ONH wall from the cremation
thamber, butscore minimal dust and residue WII likely be left banlnd. The oemtlory rill MMrale ins e=l and foreign Me all from
tbergn ,nsaMNalnoden%llmd"gnmeleMlmllbedispo otasreguredbylSky Thep¢meledremainswilbemBMOnicJ
weaved I=small pies and placed into a designated mntaner or um. CT Mbalm gem led am WlvedaadUMI rib
single M1egmanl is moognl ble ass WSmm.
OPENING OF ME=WAINER
TM1e mmmm may only open the wrideer holding Me urtcremmSd human mm0'Me in limited V=mffin Isla to oMand the
iaeMgot Medemssedormensum Manomatmiallse dmMx iMmiaNiruumempbYnssbrf maw Meconelorypopwty. N
Mmtnm im am delivered in a container Which le net eu is for CIWmoon such as mmmonlal or NMI cal Ma
0Mmry will rWi m M rem at e alm the moved Imo a sulYhN cb Onerb M It accepts Me romans. The bpning 9a
M4ner or the 4ent or removal of shams vnll the mnaucM] afters symess and will the does in aivary,WO aignlry red rasped.
IDENnFWAnM OF DECEASE➢
Nim Arl Msrco Smile
Non¢MCamaaed: Mental StBNs'.
Laid makingPLbms'. 3} J p. enrr,srt�''At Frontier Gcmem, NY 12859
Piece of Nl SMBbMBM 1,211 CMmh 6treeL Samosa Spings. NY 128ES
Sea: DM OF Age? 0011 O&IM020 DgyMgptM: C6DY o Estimated VJCO 0Igs
Description of caskVYwmnMrIn Whim AmBIne MX IN W Y .
(SNimatenal/modellmanu Mmp MaMairehrom VPoW aM GerdbmdCmmetion GaWlner
PERSON IN CONTROL OF O6PoSIIION
(Persm(q In conhol a!Wkposibm,Ng1E1 ONE of des MkwMp)
I ways are Me deskwSI agent M the dBc¢aeN desigwed in a WH of w nlnstrument eXCN pUmueM to Public
HMO tax Section 4201.
VYfk)� IM1Ve havens km "e Vat Me Mmased emcNN a w nSamura2 pumMnt to Public HMO use Damian OAI 01a
va 11 cwwnng dimcooneb Me dmry on of his or her mor iom BM IH.d ra the pamllsj Nveg Monte under PUOYc NeaIM Lax
Semen 4201 and have lee right M dLMn¢e oematim Of the remain of that damned. Slightly MCBwmhb to"ra dace leas
blbas
And Png9 Mnn
DOS 181(Rea NVI5) Pays I of 3
Authorization for Cremation and Disposition
rTa for"Me Nl e6bwl
rvumEw.° Desmpprn: AsurriviMMnrs
1. Acerswiong arrelard in mMM pusuammPudk HealN lax SeMrl azolfJ):
]. The wwlwng spouw,
b. The Surviving pmlde domestic
i. Away
A Asur,yygfrdR a ra INegampker,
6. A rearving ainlggM years olag'ewdw
F. AlyMulyapponkdWiaR
T. Any mn( ) egbssionyears age or door eMll¢EWaMrein Me estate and TOl Wary dpeBe in relationship to Me Geaee0
B. A MoleamMeadudsrydmeek. l
on
201
9. A dam friend or artery
cMpty a a pr am mien alaKmeMpd Socialist
to Pudh HealNbw Court0oarour
10. ATother perogv IN e county w ep of MeklatrMTapm and has addre s whomrNUMcgreaeaCwrl Parsund AN
INS. Any yeadonsm v.M10 is erling on EMattol Me 0.ynaaaE am and has eseCNeEew2en ffikmenl WreueMmPUNK NwMf
Lare
42019)
� OftMkwMp)INVe thereby
IMIe nereby aMM that ae body M her bmaam bee nwamfan a ewwy, beery reds, prover NO remmaw imdwt
or 2Eloadtve deice and Wl any soon memory many ATOW pier W Me 9mulm of Nor AWMbtlM from FYlum W remw
Mon IMms enter b crammon Tsy man harm W Me Cmrubry end minimal br aMi.
( ti IM4 affirm Met lnarrators,More been given W RWM I. Densmore re
regarding the rempwl0 aM personal prorerty or other rlvng of value Midi any person signing bebxw any hinny membr of No
dewaeN Wa1Ta W peeaw. PlMviex LremMnum
is nW reaWneide MMB r¢mWel plpersmel items hdn Me rvnralnel or M1Om Ib r6meins NMadamaW. PMWI bons Ml In tlw
<onOlrW OIMN MB mmslnBwlll bdghoyad Yy Me cmnetlm pTwes eM unndbe rehlswtl e11NCRmslbn.
Mre bnb/agM = Pirevisw Lremaraium ¢nwvwm
W member Me mnalns of NO MuseM.
FIaAL SMSITIOH
The person authorread W rereF9 Mr OemeW remains IN to de'sY9d IrOT Me Vein le
Naft Rood I. Denanxe
Mdmm,p Merman Avenue Calms, M' 13823 phase (618)85683&5
him me rwlansddwsuM wl by domed of as Mon:
M M am rbaon day naTwWredons not de pwastim W My a insane.
PlMvew Liememdum isaMwimd mgYnpwwsiwnd
Me remalns W Danmwe MH I4me, Inc M ddiverY
Nye, �, Arm
In person or by himpared red
Mine mad M 09
DOSl6 fMay WITS) mMu�o Pingi
Authoriution for Cremation and Disposition
r I un
IMb unCershMMallfNe remtineara Mtleime]Wryn 13UEera olpemellcn,
Pirbview ClBmabnum mey depe%W M9r&rane in
an nmlrlevame manner, inch as,by s^dllming.
L'BF)!sT M COMB NEWRN
n orvechme ronprwny
M non M M USatl ae a¢nlaiMr M11'e omnelN 9nYw M9 Ee¢n WrMwN hPn Oensmoie wrwtl Noma Inc
am laewcheae as bbwaM.Nc.... .!-�"� G1�aa.. urn
IMP uMendana Nil If Me um is tw amyl he edge She enOrt V¢m9rN remeMs an additional rigC mOaMr an"as ueb ror aawary.
OF
r
Mum'n nwyN pucNml. LM1W uNerWntl Mal if no um'c WrtlneN wdMm'ee{roNMe
Plnevlew Cremalonum 01 plsA the nrtiMM remains in
e rigid temporay container b bWay.
lNb AUMMaafbn Form vies provided!by RCM.t 1. Dis a roe was executed a1
per Densmore Funchal Home. me
Snerman Avenue. CmrM, NY 12822
Areas b
and is Signed W tre Nneral drecler as x ess to Ib ex on. Naaw
IAMB non rewiv rl 8 wmpl&M wyy of MIS AnMarintlon Fenn.
The WwoMa) iM W bees Ialae Me penmis)In conbel W dessallbrr,wno by signing MM AWerbeabn Form,atsi
w Me accuracy areal semPlNnwe d the inbrmalbn cadalrM in MN ANXMrm'wr Form eM xMortrgy red fleas ing.
Signed Me aM day d Seplern0ar ,� 20
EnW Mane
'357 Nm6 A Pores coon» Nv 12M
VARTNEW
road da,wwl a SareseW++i
1re10
�� anaArNx woes
DOS10BS1(Rev.�'15) P"3013