Cowan, Diane N. Pine View Cemetery g Crematorium
Quaker ROad
Queensbury, Ny 12804
(518) 745-4477 or (518) 745-4476
FUNERALNOME _ R 0
-- - - --._.._. RETURN TIME _
DATE S TIME REMAI -' "-"NS ARRIVED AT CREMATORY:
NAME OF FUNERAL DIRECTOR OR EEGRISTEREO RESIDENT DELI V� 6 REM' NS.
NAME: Cajiw _ .__
.CASE 0 TYPE OF CONTAINER � 1I��F� / —�/
PLACE OF DEATH:
ESTIMATED WEIGHT OF REMAINS S CONTAINER .
PLACED IN HOLD.
PLACED IN REFRIGERATION:
DATE OF CREMATION
TIME STARTED: _ __ YbnmE cOmEp; 1 f�-pnI-�
PLACED IN RETORT: .___ (( ppper�� zT
MOVED
RETORT If IN WHICH REMAINS WERE CRFMp1TFO:
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORTHAN
8�HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE TIRE CREMATION
l G SMALL R[ RETAINED ry THE PERMANENT NEE OF THE CREMATORY,
wv Sbie
ON es OFCEiXel309
EWYORK Division of OMSION OF CEMEi611F5
STRTE OF pmmemia
OPRORTUMMI Cemeteries Chrnoen Ammer
Team rev.1518147445226
Authoriution for Cremation and Disposition
This AUMorhatlon Form must m compbNd and signed prior to 0allvary W remains fore tension.
Dee: 09/01/2020 Number
eremahmy, Name:Plod hill CrrNnatay
Address, Quaker RDatl Queenshury NY 12804 Phone: (518) 145-4415
CREMATION IS AN IRREVERBIRLE AND FINRL PRWE88.
Cremation is remand cut by gleans the remains of Me de ddW am Nan consider holding the remains Into awme0m Weber"am
they are amended to intense heat and name. rro hest.mnenesln Inelmmle.m consuw 6Yarymme muwq mne.rre nreleL
which am ad that wig the left mar cremel
Following cremation the eenmry o wfil lake Raical soars to money all W ate here and ushe w r mmnal made Me mamn
Cal but some minimal dust and resmuewou likely m medics m. the wmaWry wdi>.pvm mcdedai am rwgn m.lerol Mom
the min ins and the lnad Mi and nmign mernal mill m aspame w es ray ire by hew. ere wmatea remains will fie memanR.Ily
pul"ona imo small paided and democratic c a downgraded octalam. C�r am gomrall amw YamadunNlm
single asgwm F is nagnieabls as skeletal anene.
OPENING OF THE CONTMNER
The crematory may only open the research holding;the unommated human remains in limited awmardmas, Such as to Confirm Me
uanthy Oft demanded ate ensue mart,matehal is enawm whim might injure employees meanings the someone Iaestrty. N
human remains am ftiv Ms comalnerwhlmh is not suitable hormonal such as mode lW or Fatal caskM,the
rem.my wYII reRum M.ttro iwrrelne m nmYw hen.aulmbla oomsnse IeroF x.cFpr In.rehears. The opening of a
demander or the transfer or wheval W smarm Wil m conceded homes a wires am vall the bite in pirl win dignity am rMpe[I.
IDENTIFICATION OF DECEASED
Name oft aam. Diana N Cowan stems Slays: wwo
UP Known Mdreaa:39 kO rgerme Drive, Queen ibury, NY 128M
place W Death , 2"Cleveftlale Road, Queensbury, NY 1281
Sea OM 19F Age: 89 DOB 1MV100 hole mgmm: IM11=20 EStlmNad wagM l.&S
Deamll a wNwmdaiFe M whim Finaine sill be demanded
Buffalo Casket Co—Alt Container
PERSON IN CONTROL OF DISINDSmoN
(Partners)in wed deformation, mean ONE orthe Wmws
Iweeks are the designated answer m um demaaed dmanded in asoul in woman instrument er outer Pumuart to Public
HFm Law Semen 4201.
OR-
99C IM'e have no monsedge that Me Measured concert a woman returned small W Public HaeM Law Scroll 4201 or
will demanding hasomd Ion the arrested of his or her remains am Its are the Meado s)hiving proday undo Public Heats Law
Semen 4201 and have the right to summers weaver Wate remains of the deFaFd assume relationship to the r eavad as
room -
Diane N Cowen
0O&16964(Rey Miss) Page 1 of
Authoriution for Cremation and Disposition
(InaBR Fpm Ilre N.Y Cebw)
Number 3 ointment Child oyrair the an of 18
1. A person tleagreted in wrNra Wnwnt to Pudic Nests trx 8e2ml I301(3):
3 . The
eummng nodded
oW iparer,
3. eny SUNNIg Mla elahtem "am of the Or needs
',
A Asurrrvirg parent:
5. Asurviviry ugirg ighteen years M Me or chi
S. AIhei Adornment pension;
T. Prey mother)ignteen Mum IN rate or dder en0lbtl to she In too e9me and no Teem Oman in meebr2Mp to the Oar ere]'.
S. A duty appointed fiduciary of M1e hal
p. A dose herd or redlrve wiw has Mool a andmn statement pursuant b Pubi Heats taw Section 4001171:
10. A Niel fiwl officer of a murry or a public admimMtor Monsaed Measured b the Sanctions a Cor Procedure Adl
1a. Any doer Mi wlw is acting on behalf m lM deeased and who had executed a written sbtemem punwm to Pudic Heenb
IJw SBUb1 4301111.
ddioRl ALL THREE Of Me Machine)
;'DU W/e lwreby atfir that the body of Me demaeed time rM Comein a datlay, luny park, power mil, reliance" 'rmpbm,
or recreation delete and that any wch materals were removes enter An And Mlwr of Ann Form. Failure to mmovs
awe Items prior ro cm^atlo^ may Weak In Mmr An Me anrrvbry and cram g parson nei.
qii b aMrmtlutingmdwrrahmeme ga nb Mail JJDaSimome
reyaN'me Me remarel dany cerscnd peopeM erotlw IdnO dvanrownitlr em peremap^Fg beMrx ermry famiy memberof Its
deemed wales bpmmrve. Pine Vww Crematory
"i NOW
ra red rmpomiMe br Me removal oly9onel liema kmm Me mnLLiM!erkdn Me mmelna dMe deemed. pemaNl Ibme left In the
container es Ylr or Me remaker ba damyml by Me creme0on pwcros and cannot as believed e%ercremaaon.
AS Me homes aWhodu Pine Yew Crematory
Ownv x..0 Mmemadtlrar im of Me tleceexd.
(ImYiN OPTIONAL)
LMe hereby auMomm tM mimed funenl director to provide Act dNlvery band CRmeeon by an aMmab
ematarv. It daemon necessary An the opinion of the bndirector, Anm l director,and answered bu toner Adpmvla Me coats mime and
Teddy ,Of euch aMmw cmmabry.
FINAL MSPOSRION
Tre person annealed brKaNs his vemab] Rmains of Me demased MOM teOMnsby'6
Norm;Robed D Cowan, Jr.
Addram: 5U9 Ent Lake Road, Cazenovia, NV 1303& mane: , 37- A
The oemebd Model l Of OeM9N*11 be diepomd Of m Nbws'.
Wind in Glens Fells Cemetery
Raw miry leer Me mom mead akovn dead;me Rude pwaemir aft vemabd amine.
Pine Vlew Crematory, is auMwlmd b give pm cam of
ve mmawb Regan Denny Stafford Fumbrel Home dy del'wary
p...wm�.a.w
In Iaemon Or by repmeme mar. Dian N Cowen
00.5-15n-1(Rev. 0A20) nay Ppe]uf3
Authorization for Cremation and Disposition
(may Me mwwMy
,W-v I"aurMnls txlMrema'mam Mdaimetlwilhmt2o NyeIXvaretion.
Pine use Cremarory meydwpwe oflhe remntnsM
an amnesties Manrcr.such r by wadedp.
caogATON COVAIMMIJIMIN
(IOdl910NEWIhe/wWMrMI
hi um to has,used as a son id er Mr Me oemewe remains hss been pur ncwe tram Regan Denny StaRaC Funeral
and is eeacriped as f g
INS understand Net it the ten p by char to hold they,eMre vemekd remains, an s ldhionel Not mntelner may be used Mtrliv
-01?p -
r", Mumis My Wr llesad, NVe uMenteM Netilrotm ie pucbwedaotlrerMee peovidM
Pine View Crematory will may the vemebe remains St
mw+era+x i
e rgld Yniparan ronlJnIXMdNvery. �
ika autmnnaan Fam sou pwaee by Mark J. DeSMorg was erM,"y at
mas I'Mob,
Regan Denny Stef ind Funwi al Home
53 Quaker Road,Quarenabury, NY 1nN
and 19 Shhhh! by May tunnel dlr%y My Nithaea b N Searcher,
IM14e have resolved a extroverted copy at MIS AY daadon Farm.
Tie parson(s) IdentMM below IYan Me prwi In coMM of tlYposNon,who by signing Nle AUNor "e Fwm,aMtls)
to the accuracy and compleMr M Na Infamabon contained In Nb AUMpintlon Form and mu or al Me fangatrp.
signed this at dry of September ,go
Robert D (Cowan, Jr. /j1cv�
5329 East Lake Road, Cancerous. NY 1Wn
Seesaw
ew feerwhaw
WnxE&4:
Mark J. DeSLnone
rwwwwwa,sm.onew�ww m-+
9819
owes
Diane N Gowan
Wasew
Dom-IMM-t Me v.ow20) Pags3IX3