McDowell Jr., Walter Orrie Pine View Cemetery $ Crematorium
Quaker Road
Queensbury, NY 12004
(518) 745-4477 or (510) 745-4476
FUNERAL HOME; _
-----no CxWEe
DATE A TI - '-- RETURN TIME
MF REMgINS ARRIVED AT CREmgTUgy: J
NAME OF FUNERAL DIRECTOR OR RECRIyTERED RESIDENT DELIVERING REMAINS:
NAME:
TYPE Of CONTAINER F�Yfj CASE M Pozz
PLACE OF DEATH: 1114 GQ� G
RAPe
Iu
ESTIMATED WEIGHT OF REMAINS S CONTAINER
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION
Y L
JD
TIME STARTED: A�76
'R TIME COMEQ v�1
PLACED IN RETORT _."� 1(/ '�111 L. _movED
1N WHI
NETO0.TryCH REMAINS CItEMgTEO:
DETAILED REASON FOR DELAY IF REMAINS WERE C'REMgTED-1^y
FROM TIME OF ACCEPTED DELIVERY MORETNgNQOHOURS
NOTE: THE CREMATION
LOC
$ LL THE RETAINC,D IN THE eEpingx ENT FIT C OF THE CxexniOgY
son Yokyet,
IEWYORK Division of ON OF wmwmta
IN El DIVISION OF CEMETERIg
°"°""UNIT Cemeteries 99sw 're'A"m,
aelkhroh "1223122a
goxM9w
Authorization for Cremation and Disposition
This AUMM[Udon Form must be completed and signed prior b delivery of malts for nremvgon.
DetC_Secomber 12,2020 Number'. 107Z.
Chancery Name: Plan some Crematory
Address: 21 Quaker Read Oueensbsy. Nee York 1280e Phone: 59&745, 177
CREMATGN IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremation A famed Out by platln9 the mum ens athe dominated and Me coMailrer Ilctllnd Ins annual I=a alcohol chamber whome
only are subjMM M manse neat and flame. The beat and flame well lncimm%antl consume awn"Ing except bone antl metll,
which are all that will W left Baer rnmation.
Fdlimmg pemation, the common,wil lake assurance seem to remarks all of the remains and other meknal M1Om He uemel n
chamber foul some minimal dust and residue sell likely b¢ I¢fl behind. The aemdary,MII monkey intlamllal and formal material hem
Me remains and the Incidental and foreign maWal wll be die of as required by have. The cremated remsens still be meGeduwlly
pulverized into small pieces and placetl it a designaled wmainer or um. Cnnas drwnv1ne goal 2M WlvnYad until no
tingle M1agment Is recognizable are skeletal Nnw.
OPENING OF THE CONTAINER
The rr¢malwy may only ARM Me wrromer holding the un. > mMd human remains In br iad umrrrstanw, such as to confirm She
IMrltiry of Me exewed orto ensure this no malarial laenaosM which might imurc ampnyre¢ardamage the crematory propMy b
human remains Misdiagnosed in a container whim is rest uuable for common such Me ceremonial or rental oebq Me
monetary will require Mm Me homeless be moved Into a suitable contalrrer before Rv¢ep[a Me remains. The opening d a
obe rot the banarerm removal ammams hell be conducted before a witness ank iu W done In prey,won Spur aM ropes.
IDENTIFICATGN OF DECEASED
Name of Deceased. Walter Date McDowell Jr. Marital SM s: Memo
Last Known Address: 0995 winged Fact Could#101 Naples Flonda 34122
Place of Death 3228 ESM Side Way For Am WILL
Bea: OM OF Age. 70 DOB: 03-051944 Date of Dead,.0911-2020 Seemed Weam: 200
Dear o,onof®ekavamtailrer in which remains cell be missiles]
Florence Ceske, plirill corrugated cardboard container.
PERSON IN CONTROL OF DISFOS T ON
(Perseids) N anchor d NSposNon, Sul ONE arms b all
I amble art Me msanded agent of the de¢ased moderated In a will or whool vacuuming executed pursuant to Pudic
Heath sew Sadican 4nl.
VWe have ow no knowledge wkN ge that the dedmMm exe a Armed instrument Assume
to Public Health taw Section EMI
or a
Il mruamldg crm for Me dlsposNon of his or her remans eM lHre are the demands) hevirg pncdy under Public hour Law
Shrom 20t and have the neatto auMm¢e cremation orthe remand or the darommud. Wy urrelvNonanlptoMdecreedireare
foil w
Wafter Orris McDowell Jr.
DOS-Need-f(Rev.0a2o) Page 1 of 3
Authorization for Cremation and Disposition
(evert M1om the fist varow)
Number. 2 Determine The Survive Spread
1. A person eearenatea in wrens pureuard to Public Health law S¢tlon 42o1(31'.
2. ITS surviving spouse;
2a. The surviving domestic partner;
3. Anryaurviving Old eighteen years of ape or okm;
A Asurvrving parent
5. A summing sibling eighteen years at age or older,
S. Alawfully annual Frontier
T. Ads owners)eighteen years of no or older magal to aM1erein the estate and who owner almost in mishonshlp to the demased:
S. A duly appointed fiduciary of Me estate;
9. Aclass Mend or relative who has eveCWed a written statement pursuant to Public Heats Lima Semon/201(2):
10. A chief bail oRiwr N awunly or a public atlminiatratw apgwmed mums at W Me Students a Good Procedure AD
too Any other person who is noting on behalf of thede¢asee ant who has executed a written Statement punuaM to Public Health
tow sedmn 4201(21.
AL AGE of He btlessuad
M1peby agree that Me hady Of the moral dereas net foriffilin a battery, battery pxk, power cell, radlaud ive Implant
ormdmdwedevimant Matanywchmetedalseras Mn prwrWMeexeo mWMis Autl HmWnForm. Fallummmmove
��Me,aass--Items priori correlated may muk in hMm No Me commonly,and p and message" onnm.
SlILIA5§arum that ma4uclions here yl given tO Claire C. KOrcpm rV.✓om
mi
regarding the removal of any pmwumI propeM or Nher Ming&Salw which any perm mgnmp below an airy firmly menast MMe
dememd wishes to presme. Pine Yew Cttmaldy
is nM responsible for the removal of peremal items from Ma MwltalnM oehom Me remains of the Model. PenomI Mama ten In Me
�om�m3�dyw(/�m��i��� Me remains well be dismissed! by M yee channel downgraded"must b retri e eved in after rega .
\ e Memory a dimus Pie View Crematory
mC *W May nunalm of the Wd.
Irdtlal OPTIONAL)
Idea M1enby Submit Me named Iunanl director to povide for delivery He and thermal by an albmOe
Mabry, ITdeemed normal in the opinion of Ma Nnenl dlmci0 and to amend His form W mavMe Me correct name and
address of such atmmam amatory.
FINAL DISPOSITION
Thep n automated to modern the uc H remains IN the small dkin He oen is:
Name M. B. unrest Funeral Home
Address 1M Also St South Glens Falls, New Yak 12803 Pbe": 51624641118
The cremated remaim of dxeaeed wul W disposed of as follows:
ReW W his wane Sally McDowell
If bratty reason the person named abuse deaf not Letter"emwmt of the Gemmed nmains,
Plry Vier:Crematory Is Somali W give somewhere of
c..manwm
the marine to M. B. himer Funeral Home Try deI'wery
in pmapn or q mgiM man. m'ynner OnieMroowen Jr.
nw..wn....e,
DO&l8N4mev 0 uh)) Page 2 of
Authorization for Cremation and Disposition
�a ref
Ima anaeamm bad dme remalna are netaainadwmM fzo data abwreuon.
Pine View mabry
suasiveness) may mmem,of Me remains in
an inetnerable manner, such as W aanenng.
CBEMATON CONTNNENNNN
(ental ONE a Me Asserted)
An um to be used as a mmainer for Me amended remains Ms been purchased team M. B. WIr w Funeral Nome
and is tlexnRN as all
IMb untlarsbnd than IT the um w too wall to WU the endre amended amaire. an additional nem mMemm may be used M Memory,.
O&
An um is non yen purNesad. IM0 uMe d Net I he is purmesed a dlawlas Arrested
Fine V'aw matary will glare the arrested remains in
wrwcwan
a rigid tempoary owner br deAvery.
The Assessment Farm sees provided by chore C. I(o it was executed at
M. B. lower rural Nome nw.nowrv...a
1W Main 5t Mouth Glens Falls, New York 12803
am is signN by the Wave d'vacM as wM1nws b M:wssumon �t
li have re eyed a compared may of the AUMadxeYM Form.
The person id Identified below blare the pwwn id In control of it estimation, we by signing this Awhorhatlon Form,amat(s)
to the accuracy and constabularies of tM iM matian consul in this AUNwhetlon Form and almost the Runway.
Mlgned Mil; 12 dsy a McPwber p 20
Melly MCLhwallQ� �A
LMBMN WFOMCownp101Nap6e Fbr M122 6�6
waves
row 4d
WITNEn
Cblre C. Norwpks
f 1932 wevr cwair%,w, w u.ntiawr
WekerlikDowell
DOS-18gNf lives DOM PI a