Loading...
Rosati,Rosemarie C. P'ne View Cemetery 8. Crematorium Quaker Road queensbury, NY 12804 (518) 745-4477 or (51 a) 745-4476 FUNERAL HOME:DATE & ._ _pLltl RETURN TIME: M ME REMAINS ARRIVED AT CREMATORY; �1 NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS: ___0 NAME: - -� TYPE OF CONTAA INER RI CASE pIgCE OF DEATH,ESTIMATED WEIGHT OF REMAINS & CONTAINER._ 97 PLACED IN HOLD: PLACED INREFRIG RATIO - - --- --- ' DATE OF CREMATION: _A,j I tOUR - __ TIME STARTED: TIME COMPLETED. PLACED IN RETORT z^ - .. _.._MOVED - RETORTIIIN WHICH REMAINS WERE CREMATED: DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE MORE THAN 48 HOURS FROM TIME OF ACCEPTED DELIVERY'. NOTE: TKE eMATLOG O LL gE ReTANLOINrx[ nrxER mwxexiFILE Or TxE exeagronv. Dammm.Yuri mama. ONEW YORK Division Of OrvMIONMOFF CEMETERIES TREOF 0.wf nPl >FONTUXm. Cemeteries 'hm.rrv�"AWear TriaPaom'.Is81nn6226 Authorization for Cremation and Disposition This A,MDHWUon Farm must be completed and signed prior W deliveryeremaing MCMMMlun. Date: 9I3 hD Number: fit Drammory Name: Plinug Address: 4 Qir—Q b&s N /$DY Phcw'. 6- CREMAMIN IS AN IRREVERSIBLE AND FINAL PROCESS. Cremation Is carried out by plocing Ire remains of the aecsesed and Me carte m holding lee remains into a cmnknon chamber whom IM1ey are su0ietleo to Intense MM aM flame. no bat and Merrill lnCIM Me and consume ind ryNing except bone aM mI whim am all that wilt NO lest after cremation. operand cremation, me cmmatery au take reasonable a mto mmam all of Me remains and inner mmarial from the aemetmn chambr, but some minimal dust and rescue all likely be lest behind. The monarchy all aepemta ndidenthe and terelw material from Me affird and Me Inddentel and Ramada materiel all be dhpmea of as reyoved by has The aemga mmams all be memanlwlly pulvi Into urall peon and plerwd Into a designated Ontario or um. CmmMW nmalns penermly are pu"da until no single busmen Is racegnlwble as skeletel tlnw. OPENING OF THE CONTAINER The aemMo mayonly often the consumer holding no unMmmad human rammrc In IimbW drdm Po stancn,such as to nflrm the Ol Ideno Me damwd pats ensure that rod mateael'a mclmed Which mghl lOuN employees or damag,the crematory property. If human females are denwmd In a contelesr whim Is not smaeH for cmmaflon .um as"mutual or rental...sate the conu�M tee to an orrrremo el of creme mvdll as cur dine bbalsfore ateMnossaaof wall d.done ods m par.r°armmon band rel.pea. OE"FCATON OF OECWEO Nang of Deal P. R Mai iswwa: <' i LastNonMdw. as h Fsd\ pwmm Oemh: 170 LArten St. Clause Ketr " 121 Sax: ©M OF Ago 81 Coco wioji= oMem Deets: z E.o EadmI Write Description of neake✓wMaiwr In MiM remains all be del hared. I Ivyf—� PERSON IS�QNTROIL OF DBPOsrt ON (Faedn(s)In rontM a d vry ,, new curve of me fd0wmg) aMWe am Me designated saint 0 the dwsasW designed In a wR or Ml iarshal t exewM1a pursuant to Pulic Nation use Beach azoi. U0r 1IWnga he"noknowledge Ma Me deaeass l wecwed a wmun instrument Farmers to Panto HHansonat Law selon 4201 or, mmm dire ans for the aiaromRan of his or her Femat onUl hs and Awe are the eera beard paom y Maker Public HwIM Law sn almlcn dgol and hmaa Me rl9i wMmae aemalcn mineral of Me comasae. MyM,r mtebwhlp m Me d,m,sed Is as follows. d aj f WS-1898-f Mil Gi Page 1 of 5 Authorization for Cremation and Disposition them lam ene nor Melee) r �t Number; J Counters. ytvn�au.! 1. A person abandoWa in tender pudwam m Puae lean,Law reecho,A20115)I 2. The sum...g arousal L. mearmory;furnace peen J. Any suMWng chain Mont, years of are or older; d. AstaiWnp paronl; 5. A mercury sibling egrom years of apa on clWrl S. A lawfully appointed guardians 1. Any person(s) eighteen word d are or alder entered to sham In Mx estate and who lNere down in wegonshop b Me dewemd: a. A duly weamme a0uciary of IN micro 0. Ackae fraud or heady who hers aeecuted a woman sUmment punwent At Public Human tow SeGion@01(2)I 10. A chief banal oflimr of a county ore public samurai appained purawnl b Me SurmpM'a Wun procedure AN too, Any other pawn who is acting m behalf of No decuaetl ant wM has executed a waidan else hM mummenl m Public Neale Law Sedan AN 1 p6 �(�BALL, MREE of the fdlowing) V � no law,heavily aMn,final the body of Me d mawa crew, W e does not nmm a tlery, heavy pack, gown col. radbN mpl ve wart. or radioactive device and that any such mammals were removed prior to le ex tom of Mrs Abbrodaatbn Form. Failure to remove melOorto cremation may rai in ham to Me warrant and summary prsmf on . e afSm Mat Insrunitlns haw beta given M McrL regarding the removal of any peleeml propam or other Mine of value which arty perm signing below awry forrtily member made dwmeed vashm a prsaahe. Ov nod. U4f,.f use.....Arm (I. A nth hepompble our the removal N peramN Items M1em Me container or ham the rameri of Me dB46eM. 0.nonal Mane left In the made rrem earth Me AM beaesrpa by m cremation e mation prece a comedy be removed after crema tion. r or lM'e hereby anMorme P wi U\.cI Ch bjn b wiredrawn tome mail Me remene of the aeueud. ILfnrie),\OP�TIONAL) ."J/ tl- . & Ilea hereby mmearhe Me mmrd federal ancestor to pmvlde for delvary m antl cremoMon by an alternate of Me opinion efthe It tllredoc m m antl to amend this farm to provide Me coma name and managed such aMwmeavmro FINAL DISPOSITION The person amhorded m m "Mev MMM a the Thre shold food tan combat to Na gr\>r Qihaarvl �4 q Mdr : b� f�IGm. �-���ii, -Phmmt Tdre[remand modem 0 deg se wtll be diamond M as ralcwe: Mara reemnlM moron nnaamed above does of tent pmsesalndMd wmama rmmaim. z U�'(w� Cyramdk 1 ` Ia aide d to give penession of Me remains 0 <r4t, ahvh, r.rJr F,,.Q _I yy tlNlvery In peon or b/registered mel. laMasue �(5xM4 . 1loc . k1 O0 llblh f(Re, Cal MM Paga2INS Authorlmtion for Cremation and Disposition wrowbgl Me uManbM Nat 0N.amens are not maimed vANm 130 Wye of uaMa . P1 YaC l�GV CKY^ea[.��v1Ln�u maYElapue cllM1a nmeW In an IrraYlevame manner, such as byxenMrp. CREMATION CONTAINEWRN (li EWfne ldbwinv M um to 0e unit as aronbimrbr Ne aemated her has been purshaetlM1mm -troSI antis EexnbeEnfolleffor Utwks� t.('1C.FY lMe understand that it has,um 13 ka after to Mtl by enan MMm nmaior an alahknn Nib corm nay be dead her aWvet. W!. M um in cot yat puMang, IMO understan0 that If no,um IS pubbot or MhetNse provides Pirc Vlew Container will place he vemabd maim in a rgid temporary,torn rer for"Intent. Xanumuau Me Autlgrkallon From was provMed by 1 ntk Is ?a fly I, n"a shortages al cvorrJ,Wonv 66 mc,, Sir µd.A&b,, ysj and is signed by theNm2l d fined,as wnMsa to he ei,so on. II hi ncpved a cumpwM copy of tMS AUMOHxallon Farm. The penurNs) transited bNow Islam We p rn it ial In coning adlspotltlon,who by signing th is dissentient Fomh sllasNal by the umy and completenessl0 Na Intensities candidate In this resettlement tl n Fot an/a'tfli Wn Me ls) bngalrq. ShindiesI M��ls 36 WYof Janes, ga µ y_J SI AI Tornw,,nmoni bases MMESS: � q DQ l80 fIRay.041l20) Page 3 of