Torborg, John C. Pine View Cemetery g Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (Ste) 745-4476
FUNFRAL RONO.
- - - RETURN TIME:
DATE TIME REMAINS ARRIVED AT CREMgTDRy;
NAME OF FUNERAL DIRECTOR OR gEG gIgTERED RESIDENT DELIVERING REMAINS:
'__. . hAh.K _p_ES�NOFrq.
NAME.
TYPE OF CONTAINEq 1'j0111 //._. _ . _... CASE py,LJ./ _
_ HtW __.LSI�L4F _AIMO(Wr lIh PLACE OF pEgTN: " f,,
ESTIMATED WEIGHT OF REMAINS S CONTAINER L
PLACED IN HOLD.
PIAGFD IN REFRIGERATION:
DATE Df CREMATION
TIME STARTED: L w rn
_TIME COMPLETED
PLgCEO IN RETORT hPq MOVED . L9- n f _Z4'op-
f
_
RETORT IN WHICH REMAINS WERE CREMATED, n
kv
k VV
DETAILED REASON FOR DELAY IF REMAINS WERE CRFMgT �Y
EO MORE THAN 40 HOURS
FROM TIME OP ACCEPTED OCLIVeRY:
NOTE. THE CREMATION D 5 _._
LL OE nE E IN ]HE nEPm
ARENT E Or ME CROMITORY,
NU YORK )IVI$101 Of DrvMN OF CEM ES
STTA °wcwnmma Hwe
°"OnUNI" Cemeteries auras^ %mare;
Tech very tsNlaNesse
Authorization for Cremation and Disposition
TM14 AUNrorlaatlon Farm must Gan cmmplai and alRne prior to del"rye remalna Mr cramatlon.
pate_ 09/14/2020 Number.
cmmNmy Neman:Pine View Crematory
Ntl s.Quaker Road Queensbury, NY 12804 MGM: (518) 745<476
CREMATMN IS AN IRREVERSIBLE MD FINAL PRO M.
Cremation in cwhine out by pbaong the rtrrune W tM haaeM wd Me contamer M1dtling the remain Into a U maWn diameter Wren
they are subjccleE to mknae beat and flame. The M and Nma will Incinerate and consum an in ancientLMa utl rnWaL
wM1 h an all that will ban IM after ce on.
Fdlowbrg cremation, He uematory will take re mNe¢Nona to remove all W Me remains and one material from Me me n
chamber, but some mlmmel dual and made wail likely W Im behind. rM vem.tory wiu eewrale Inutlentel aid mieiBn matenY flgn
me rcmama and the Ncldental and foreign mataial Mn W dkwmwd1 of as nauiRd by law. The vemaled remains Mn W me anCHy
purvedam into small pear and wa¢dlino a dvGma container or an. Cmma mmins ga mld am pul"d antlNo
i inVle fragment is mcoent W as skeNtal Status.
OPENING OF THE CONTAINER
The cemetery may only open the C col Mldng the unO"m human roul in lunged circumstances, such as to confirm 1M
eentiry of the demas ore ensure Nat no meant is technical which trial Injure employees w damage the crematory lxomny. N
human remains are bllnrw Ina continental arot sueaela for cm Lion such as cearromal or metal cal the
mnhiecoal will Muimt Me mains Is means Mae subebH Michael Eb an H accepm on the remains. The coming ofa
r
or the oaehr or mmovm of min ins well the conducted Geoma a wilrese ant will ban career pMal with than"and respect
IOENTIMCATIONOFOECEPSEO
Name d oceased: John C Torborg MNNISMma. Marred
Lon,Nnpun pM :12 Shallow Creek Road, Queensberry, NY 12804
PIa„y a 0aath:The Rnaz tK Glans Falls, Warren St, Glens Falls, NY 12801
Sax. ®M OF age. 17 Ile: 1VOW1942 IJMMIMath Wila2020 EN w M: 80 kg
Ns on of usxWmMimr in wen mans wo WdNlrerM.
Buffalo Casket Company—Alt Container
ELMON IN CONTROL OF OISPOBRMN
(Panel Go en &daphiA'n,jal ME doM I[MMp)
YMNe am he dee'gnmed anent Nthe din designated an a will or winner mnN M axecMed pursuant b Publ'C
H fthl S n4201.
` IM'e have no limestone that the deMeud executed a vmeen irmimment Wrsuenl to i Health Law Sector 4201 eta
vn mntainirq matter;for iM diapa&dm N his cr Mr remake and Ile ere the MnGnLH hating pnoraly under Pi Much Law
$Bctlon4M1 eM M1eve Ne rgM1t to eugwiZe CRmadon cl IM1e rtmeina Wth cFeaaed. W*urrNal hipb Medecooe IvY
fWlawa:
Jahn C Torbory
005-1894t(Rn. "no) Pies 103
Authorization for Cremal and Dispusidon
(Maertxom lee aetmdwl
Number 2 geeapion:5
1. AmmandeaS inwiitirgpumaMm Pudic HeaMlan'S tiun A30113a
3. Tm starting epoid e',
L. 1M surviving aonrstic tanner
3. My suit ing unlit eigMren years of any or older,
L AeuMwng parent
S. Asaintl stag eighteen yearn of age or dmn
G. A laxmlry schemed Partner
L A"reraonlq maned yaws Made or order named to sham in Me estate and me kinds doses)in rNeOWamp to Me moral
e A duly medical dinner of Me esbMl
9. A chase Mend or hall who has seated a which Adamant pmuand m Public Heal Law Sidecr4201 py,
10. A MM fideal oM¢r of a wumy or a pi atlmiriitoww eppointM pureuent to lee Surrogate Court Pr Kure Al
10a. My Other named who l0 ad i N on term OF Me determine add who lusexacNM a writlen statement pursuant to Public Heats
law Seat L201(7),
( %gJAU MREE daro M'owvg)
hA Me harder,athrm Met the bay of the decrease pea nN mntan a Miami binary pat pw.'erall. ndmclive iealanl,
or raiwetM eewre one tat any such materials went remmied pnorre 1M execution of Me Meson adtlM Form. FalluR to Move
Mesa tame War to channel may deal In Man m Me cMatory end channel panonml.
Ullr Me arm NM Instrument nave men green 0 Mark J. DeSlmone
regeNing the h novel of mry peroiul property or otlnr MN Of sham which any pence sing el ning bow or ary fal member MOle
decrasse wishes mpremM. Mine Vill Crandal
n ram reaponwbm mats remdr.I dl mnddal arm Mm Me mmaimr axon saw
rem:manle mmmea. Pxsaml lmme f.n mMe
on(�MM`,�m,�r d.wM ran nm.m.w:n m d.etrdym er Ma enm.mn prmxe ant denlw m r.hm..d.mr anmmon.
�tarn heri auMorlte PineBW Crematary
x.w mem time rwrralm a Me aedaeM.
(In=OPTIONAL)
VM hereby withdrew the names funeral dlrecmr to pmvlde for ddNarym and cnmatlon by an amends
cmmmry, N mxna necessary In has oplmmwn of the funeral director,aM to emend has form m provide the camp name and
MO M such amman cnmsmry.
Fli MSMS ION
TM pamn sightseer m another Or normal rwmlm of the aitewed hum the fnmwdry IS
Name:Rose Mar'le Toawfg
Address: 12 Shallow Creek Rd, Oueembtay, NY 12Na- plum (518) S3&3tl5T
TM uemeted rmssne 0MwmN MII M®sF MMn Mown:
Refund to Family
rcM am nmmtMay wM funeral eMromm rW mice pdsansion dMe aetrmiw ends".
Pine Vlew Crematory, maummsdmg'ne pasaesaion 0l
Me Maimm Singleton Sullivx,,.an Potter Funeral Horne byml'mry
m.-+ ..m
In penmr or by rag men. John C Torhorg
005-1IMf later. M(ea) va cat
Authorization for Cremation and Disposition
abeg bes dwowtni
L NNe understand that dNe remains are out cause !whom 120 stays Nwmatim.
Pine View Crematory mayaep®eMMeremMre In
awp
an irrNmuaGM manner.such as by eCeNrirp.
CRFMATONCONTAINERNRN
(PEE ONE or the falbwma)
An um to by used any a mme terh r Me dynamicalremains Iw been purchases rmm Singleton Su hren Potter
and is chartered as rouo-n:
IM/e maNRr➢N IMt xtlq vn Is go,small to hi Ma"m aem9Nd manderu,an a1]2oret rgid Resells my W wind MdW Wry.
OR
} a An um 4 net yet WrUaeed. Me uMerateM NT Hro um a punAeved of almonds crossed
Pine View Crematory vale place the gemmed remains In
a npp temporary[4utelnH bay EdNry.
This Audronzaw Form was pmvked by Mark J. O Simone was executed at
u.m as
Singleton Sullivan Potter Funeral Home
ewd:fe s
ap] Bay Road �ueenebury NV 12804
pw..�u.iu.w
and is upiwd"a Nnerel director as scheme W N exeeution.
Vice have received a completed copy or had ArMMaMlon Fomr.
The pemomish IdanrMed bedew WFR Me pnon(q In cons of dbpsal cobs by signing Man AU d"Wn Farm,eResyet
to the accuracy and compote of Me Mlomutlon wonered in MIS AUMwlzaeon Form all*u orY s)Me haragadng.
signed Mia 14th dayof September p , 1I
Rose Marie Torborg 1 III JN b I ItE
12 Shalki Creek Ski DuearlWury, NY 12804
nw. +ram
MBA J. Dasimorle
OH1H
John CTor M
da�aa�V
C08-18984(Rev. 0a120) Righ 8