Baker, Lawrence James Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: _ ___
__DFYsntGyh,
GATE S TIME REMAINS ARRIVEO AT CREMATORY RETURN TIME
NAME OF FUNERAL DIRECTOR OR RECRISTCREO RESIDENT DetIVERb�w 'M�"
ING
NAME: ------
._._.
._
TYPE OFCONTAINER CASE a FkN 0✓Y -
PLACE OF DEATH; IIke
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER
PLACED IN HOLD:
PLgCE° Iry REFRIGERATION;
DATE OF CREMATION
TIME STARTED;
--TIME COMPLETED-
PLACED IN RETORT qy-I yy
-- n-._.
RETORT /1 IN WHICH REMAINS WERE CREMATED;
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE T 4S HOUR$
FROM TIME OF ACCEPTED DELIVERY:
NOTE. TRYCREMATION O
o[ n IN THE PERMANENT FLE OF THE cpemniORv.
Fro
k Sony
{�1 CenanmaR&t w
EWYORK Division of MVISIOo ,cNrre"Ph "
OF
OPPo0.TVNITC Cemeteries tim,rAapm
Telermi,adler4ul
Authorizimtion for Cremation and Disposition
This Archangel Form most to comple and signed prior to rlegmury o1 remaim ru cN Oon.
Date. offtedi Number. 1016"
Cranial ry Name: Pines D'hmamiuM
Address; Rl O uaker Read, OWTYUry, MY 121304 aMemer (511d)74 rr
CREMATMN IS AM IRREVERSIBLE AM FINAL PROCESS.
Cinnaminson l5 bawled for W OwN tlN r ns ofMr0.aM and Oe cambial holding;fire nanyna Into a�TenxsxlerB
"arsupx mIn@nsehostaNflame oINM11,
Mrlcx$Malllxat MilxekNabrcM Von.
Following Cremation. Me uemat"vnll rake reasonable elbnsm remove all dine remains and oNa maternal frown Me common
Cnember, but some minimal dust and residue All likely he left behind The overstay wIl sryiamle Irademal and mrelgn material from
Meremainsend MemudeMalaMroreignmmenalwilbebiapmab Ofea Mulredbr Iaw. memmatedremains Mlibeme ni[
pulema Inmsmalpiewsandpia intoaeesgn r iwawn Lmnabd Mnalm gnemlh en pulwrYN uMlfoe
aloeta wgmem I.hwgnlnme w akard.I goae.
OPENING OF THE COMTMNER
The vemamry may only oven me amaex holding un unoemamd human remalru'm limited ai m& nas, ni an to They
identity arms demaaed orroen tom that ro matenal ie mated which might m um mdoreesor Moral the normal p'CpeM. N
human Were;am"1,w Inaconminar whal le ford sulmxle for cramollon such as oeremoreal or rental "Si had
W .i Mll heath Mat Ma remains the mow. IIntoa Rmarbm contall Wore Maccwb me remball The Waning or a
mmaner or Me boader or removal of remain wn as all a wlness and all be cone m prlvac MM dgner and respect
OENr FICPTIM OF DECENSEO
Name or� Lamwas JaMN Bekx mmwi Status. MaTBd
Lob Mnocn Alludes: 71 Nwth chemical Rind. P WGmna. NY 12859
Play of DeaM Mi Cwror
Sex: IN m D F Ags. n beg Its"ll913 Dab of reason Varies D EMmemrl W ft Ish
Desalpbm of dynamometer In wham remains al to delivered.
RypelmabnaYmwkVmenuram symbol Auma VIm]aq Corm dQeme Conemm
PERSON NC(Affl OF p MgPD8al
maaartal mmnaaelapaawm.�yoNE wlMmimwngl
anare Me eeabnared pnt holey ee®saed dwlgiwtad In a au awnron Mmrumenr a ecumey pemuem ro Pubtie
Xa+lN ldw 56CLm an 4201.
AR IIWe and foprACrd ispo Marl ow deRasedemains and likes
MethodsMnurwavim Pumm Mover Iaw Se mA the ors
nwnmimparemuna for istla elspoMimofheraher rememsamellvc MS
pe , gihanngonoMrunem aubilc NeannL Is
section aani all tmwnie igmm auMorlu oematiofo ornre rem®ns dNe dereased. MrfOin relauommp m Me daceeaed Ie a9
rollmw:
Iamwin Jam"Faker
DOS1594Tf(Rev. =15) Page 1 of]
Authoriration for Cremation and Disposition
Onwd rmm MadMmWw)
NumEP: 2 OeacnpOM: The surv'ning Winds
t. A rersm Magneted In vwmng pursuant to PUWC Hal Im'Semn 6Nlt(31:
3. Tlrt survmng spouse'.
3. TNewmingdomescpaMer.
& Any wrvrving OW eighteen years of age or dM',
l A surviving parent'.
5. A survinng malmg eighteen years M age or older,
S. A rogyngy appamen Moral
T. Any,psern(e) inghteren yearn or or or older rental A siren In Me ssus aM aMloans clmesl In rela4onship to the sooner
& Atu"Pipla en ROuchary Of Me estate
S. AGpse friend or tell and has adorned a wnMn sblemem pumuant to PUMIC H¢aM taw Sei alpt(]y,
10. A tltBf Mind officer of a counts«a pudm aam Inge or appeal punsuam to Me Managers a Col Proedure At
IMO Any other person onto a seeing on bMaN of Me Oewasen and and bee e,ecuten a wntion deremend purwant to Pudk Heigh,
lax Se9ai 4201M
✓(rjlgI ALL THREE of me MlWbg)
/I — INYa henry emrm Met the bd1'of Me OemeeM arcs not mmain a Larry battery all pmrer Wlr mnlWcWIm gent.
«raaioaviiva Dance 9na thMany wrii malenala nee remowdpnwto MeevecutionmMie AUMorin Fam. Fanumtoremove
` Nw hands; prior to crematlan may heard In teem W in ,cremeMry and cmmW ary personnel.
RLL 21 It aMm thatlnsoutlime have Omi®wn W RobM L Consumers „,uw
regarding the removal Of any personal propwly or Met M1rg Wvalua Mich any cemw signing hekyw any family mards,of the
Fishing"Cremeknum
nece65e1 atones to presets.
is hot r WG,ble M Me removal or ceia«al dame turn Me mmaiirer«Gam the remains a Me dereawd Peraoral free oft M Nov
��w/rn�r mnL/e.,r«MM Ma remairre will be deetrgad by Ma creme POM end Call be ranbaed afrraremetlon.
IKW hereby auMlROr Pin¢ ew Cremalonum h
i,W cremar Me remains W Me tlecBBNd.
F XAL O SPOSITION
The Moon fardideral dd eM ive Me rmmebod!Monte Ol Me da-aued ncmtle oeinekry is:
Hama: Ruben 1. Nensmore
AWrees T Sherman Avenue.Cwl NY 138= ppppe. (518)(MIA 85
This aemeted remalns M deaa will W aepawd M as Mlwn'.
IrMenrrmWn Me pca«nametl aWw Mes not lW pweeNm ant avruM mmama.
Plren"Cr mum mwMcnxen to gins posaeeaxn or
Me mma'ma to Derwnma wmral Wit.Yc rw.n try nmvery
P..xx..x.,r
W paron«bar" Mad hug.
Iaw.ercedMnea gaga
ppS10BEf(RB`i.&W15) Pal]ol3
Authorization for Cremation and Disposition
!mn�nrimn lmlunrrel
V/�•J Wan uMmland that it the remains are M daMM VMMn tat Mre a OBma4M,
'nwase Cremaonom
an whydr avaae manrer, wed am Men timesharing
vain wren may fasp�of the rtmamm
CRENAl1ON CONTAINERINRN
((ggigl ONE Ntlre lollvmy
An um to to used as a container for Me vemaeE remains"a Win pumMa¢d from Danmare Funchal Horne, Inc
pled ie deemoad as follows: h
Osm understand Me it the ahhhl Mean m how ds Mere ams.M addrional IJb OMt'ner may W utld M farriery.
OR
_Mum n M yen WrUa6ad. IM'6UMY81t9 NNMrq Vn U WrMaME Molhe'vAse PmvIEeE
Plre wCmmwmm wall place Me vemaed remMs an
e ngq temWeryronairor brdeNvery rvmam"We
The Au(Mntratbn Fam away prMdea Ey moment I, Dererme ,w eased N
pxweumwnunw
Drennan Funeral limnq no
T ShenmM Auonun,CMMh, W 12= 6usdwemnr
and is tagned thy Na wheal arMm as entries ro Ik eseatlm core�m
WJe nave Minimal Whitest copy otmb AUNMlaauon Form.
The persorm)wenNed Isms Were he pRorm) in control 0 dMgmiton,wTo W angnnN this AUMonuOon Farm.ally (s)
b the eaurary and cdnPlaMw M1M lMornuuon cordainad In this AUMortretlon Form andaNM1orla(s)arm fnneyng.
Sig Nths BN daYa SMm'Rer coed
Ba2era Baker `r�i✓a
T1 NMhGmM&M Rmf. PMM Wrera NY 12&w
�nrmaaOaww seem,
WTNM
I Rest :
Roam I. Demncre
nmft my nwwrnvmm� paTiu
m IaMerra Jamm Baker
prw®a
ooSld bf(hear. why) Pge3M3