Slater,Margaret L. Plne Vlow Cemetery g Cremitornum
Quaker Road
Queensburyl ryy 12604
018) 745-4477 or (510) 745-4476
FUNERAL NOme; _
GATE A TIME REM RETURN TIME.
gIN6 ARRIVED AT CRFm4iOgT:
NAME OF FUNERAL GIREC TOR OR REORISTERED RESIDENT DELIVERING REMAINS
'P44... _.per.. -
NAME '- -
M''14p9 .SOTAZ
_-CASE "
TYPE OF 7Ojr
CONTAINER Mq♦�,NT� --._
PLACE OF DEATH: MO _ DAY ..� I. t d4r
ESTIMATED WEIGHT OF — - _REMAINS B CONTAINER _ _ qN II
PLACED IN HOLD: —1iiN Jh•
PLACED IN REFRIGERATION; --
P'L�1
DATE OF CREMATION.
1NIm
TIME STARTED; -
_- __TIME COMPLETED.
PLACED IN RETORT p6`G'M
HJ MOVED: .1IO
RETORT IN WHICH REMAINS WERE CREMATED:
DETAILED REASON FOR DELAY IF REMAINS WERE C'gG
FROM TIME OF ACCEPTED DELIVERY: MATED MORE THAN OD HOURS
NOTE. THe CREMATION LOG SHALL
BE RETAINED N tME PERMANENT lE Of THE cgeygTDgy
,
m York
sum Dapae e
MEWYORK Division of DIVISION OF CEMETERIES
bad barrel plaza
°POR UNI^ Cemeteriesove. ,^„^1°0001
hai nor
Authorization for Cremation and Disposition
➢,Is Au11w UOR Farm must be mrapMYe and signed odor to delivery a remains tor"IM&tlM.
Date:D91151PaW Number 1021"
CmwM Name:Pine Van,CnmMMum
Mdnc:Quaker Read, OunroWr. NY 12004 Prone: t
CREMATION IS AN IRREVERSIBLE AND FIN"PROCESS.
Cremation is miner out byH
pMtirp Me remains of Me mma¢ed and tM ¢Omelrer holding tie annual Into a normal chamber Mare
ry Mam SUbpGed heat and fume. no Must and flame All lnclneM and Cemume avnyMmq except Done and mNt,,
which am all Mat immense
IaR*Nor emanation.
resume command.the consul win take micas eaffordw remove all of Me remains and odder member from Me bermakn
chamber.but wmo dri dust and residue all likely be left behind. The cnmamry All fundamental aid foreign mineral farm
n¢aM the Inmamm and moral nom al Mn be composed of ae reamed by law. no aremned remains will b bammly e me
pnlverlaea lino¢mall pram¢and several a designated comuna,or um. Cr at ,wmlm generally ahe"lvad until no
¢begin frogman m recognizable as sellWm¢aus.
OPENING OF THE CONTAINER
The framework treymy down Me container holding the Monorail human remains in pinned tircumstenm¢. food as to deal des the
dent"Wthe demanded or 10 draw that normal is monaeco whim might dium emwoyeas a,damage the crematory Nomura. 9
human remains are dOlvend In a container which Is out noble tar curnstion such as aenmonml or renal makal,the
com moved
ainer
mMalit will�uim Mat the ne or Me trumfor or m moval of lremns alns well belmmnal melon atwmess end Will be done Innovel wish all aid soya L
IDENTIFICATION OF EC�ED
Name of Crowded',Maganl L. Slater small Setury Married
Led Nnown Address:b None Came, Hudson Falk,NY 190AJ�9 /Y Y.'/yy
Had of DeaM:�' A4P89 ORaf/!O /l t 'S+ —Q&A6ITyft
sea: ❑ M IMr Age:73 roe. 1VO511W Demnowm 0911a2BA Edlmatad w.ight me IN
Ceaurptlon of caeNmrtamer in which remain$All A deliver".
Matthews Cardboard Crematton Tray, Wood Bottom, Cardboard Top
PER90N N CONTROL OF DISPOSn1ON
(r'dmn(q NcMWl of natural Mni PONE be Indb owdgl
I am,Wa are the eulg"ted afford of Me Mutual dWgmWd m a win or written Inmumem deal punuanl M Public
Heats Law Section 4201.
-OR.R.tt, pq
11SdL Me have anM knowledge al the Manuel execuM a wtl0¢n Installment punuanl to Pubic HealM low Section 4101 or
mnmaing dlnN $for Me dapsNon of he or me remain,and Its an Me small )were printer under Public Health law
Semen 4001 and NO the yin to awhome cremation&me remNln W the eee sed. MylOurmiMionshlptomeeacaa¢ed I¢ae
follows:
Margaret L. Slater
D0a-08981(Rev. Move) Pape 1 of
Authorization for Cremation and Disposition
nnsenawn the jai Mbw)
burial aemlp0cn: h
1. A match aasenads In asking pumuam to bubble Heth taw section 0201( 1:
2. The aurvwing spas¢'.
2a. The demand domestic pwlnw:
2. My surviving Cllila egMon"am N age or oldx;
e. A surviving parent,
S. A surawig sibling engine,year,of Who Or clam;
S. A catch moral Burman:
T. Any peman(s)criterion more of age or an anggM to share in he estate and w90 Were heaven In reahwahlp to the Reveal
a. A duty a opened ad uciaryof Me remise'.
S. Aclose Wind or relative who Has amcuWa awnaen summwe pul l b Pualk Health Law SMNn 42p(7).
10. A chief Most never of a munN or a public administrator appeinmtl pumuaN to the Surrombe a Cash Pat Are Act:
1M, Any comer as Im,who is ad,"on bel of the damned and wvo has executed a writer statement ruravenl in Pi Health
Law Section Rgll]).
Gryr 2sALL Foul 0 MO ficemf
JJt- WJe hereby min that We army alma rebound of nol wMeln a WMry, battery pact,pol Call, hoisemen Implant,
or redlimmem device and Maany such materiah wen formed prierWNe evWtm of Mls AueM Rdon For Fallureto amova
tMmn ker prorto cremation may mule In Rams to did,did,amatory and rnmbry a pomonnal.
„sf oafn,Me sfRrm Hurt Indirctess have been given M Cam K.Padsm w
rtivaMing the removal of any part pmCaM or War Wng of value wNm any grain egnhq Mkw an any femlN member dde
deceavea wishes 0 pram. Pine Viex Gamelonum
Aria
Is nco extensible far IM removal of pemond Items tram Me walker or M1wn he mmalm N Me dN sed. Paaenal Items left In the
nli or with the remain a IN 11 al a a aVDyed by Me mamYcn p edss and wnmt be nblawd after cremtors.a
. �NMe hereby auMORe R°e View Cnmaknum and Caw
he am.n We nrms of the,.banana
m;Mr OPnofuay
7_(7l�gwa hereby sahmom the named renal dWaorro art Car aahvery to,nd chiral by an aMmate
xory, IfnwmW necessary in the opinion of the funand director, and to amend this form to mavma the correct name and
address of such immune amnery.
FINAL 0MM5FION
Tnegmdn mweed in rewiw ere«aamd remains of me dismissed from We mammon m:
Name'. Cal Funeral Home, Inc,
Adams
fiS Main So.Humor Falls, NV 126M Phna. 5167e]-02M]
The amain remains of command will hedepmds a as fwpw:'.
Rxum Mfemll
If for any mown Me person named aWva axx nettW ponaaom of the demands real
wgvlew emmawmm is No ems possession of
m w he
Me arms ro adman Funds!Home,Inc. by delivery
in person or ors sNo mil. �a Memsel L. SNter
rwseo.�.n
DOS-0Bg&t(Re,Wbam Page 2 of
Authorization for Cremation and Disposition
g�uMa ralownyl
AA� Me understand Main the remame an not calmest within 120 days of synonym
Pine saw Container may dlepox of Me remains In
an manatees mennm.Such w by sutleM& Xwwat�X
CREMAT ON CONTMNERIORN
IMM ONE does nyowmv
An um to do used as a wntaimr for the uamekd Monday has been Purchased"in
and is deaalbad as Issues,
WAS understand thd II the Sun is tee Small M had Me amlrc vemNN MTeim,an addldwul raid wMNrec mry be used M deurery.
OR
4 W4 An um is nee yea pumMsed. IAYe useembM Men X no vn by WrtlMssl or Amusing pMVWed
Pine Vbw Cremaianum WNt Nita Me uemeted nauseam
nwM"rsasmva
a hind temporary mundane,be mliwery.
This A Alamo don Form wus prm+dad by Mark K. pair was executed at
CarlHm Fumral Home,ant
�rrarl
fib Main St. Hudson rally.NV late
Hudson
and Is signed by Me bmRs sooner as witness to its ea%utlon
IhVe have mus"I a com0mw wpy 01 the 4omwi lbn Farm.
The Sari IdentMed halm IMn the mrhi In wntrol of dlsis"Mon,who by slgnlrp MIS AUNotlzadon Form,afti
M Me auvnry and ommpMMnes"of Me Informdlm moral m l In MIS AUtimmew an Form and sulhoNa(SI the horpWne.
slgmd Mh 1s day or Sept Td 2020
IVlotuw,nk �JQNAe„ fFfYl/1� ou25n.�i f-lttl-�m
Assms
WTINEEE:
MeM K.Patlab
12872 o-veuvm.rvax..n
yardarm L Slear
DOSIBx-f army N1201 Paste 3ofJ