Fischer, Eleanor Mae Plno View Cemetery 8 Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745.4477 or (510) 745-4476
FUNERAL HOME (q w
RATE a TIME REM T -- RETURN TIME.
REMAINS ARRIVED AT CREMATORY: " --_ -
NAME OF FUNERAL DIRECTOR OR REGRISTCRFD RE610
9 ?.G19�_.2:aDph.- .
UL
Q¢ ENT DELIVERING REMAINS:.
NAME:
TYPE OF CONTAINER -. . _.. CASE M1 IQ. 7 Ilvlll - !
PLACE OF DEATH: - POOR T7 �
l} + t ® / u
s- _ &mod . . t r 4 '.�znkM_I¢
� —
ESTIMATED WEIGHT OF REMAINS C CONTA NFR - --
PLACED IN NOLO: /)O
PLACED IN gFERIGE!<gTl N; --
DATE OF CREMATION. p7
----
—TIME 91ELro- -
TOME STARTED: _ "
--ZQ _rIMECOMPLETED.
PLACED IN RETORT M
—� R _ ._.MOVED
II
RETORT IN WHICH RCMA NS WEREE CREMATED:
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED �4 � "
MORE THAN qO HOURS
FROM TIME OF ACCEPTED OELIVERv:
NOTE THE CnEMATION LOG SHALL RC n[♦ '-
x THE YCRMn TILE OF THE Cn EmnrORY
1.
D.Panmµm IN w
NEW YOKK i)IVISIOII Ot Dmzlo ur1cmBMerep^"ss
hwe "umin Cemeteries O P Oval
are
T.NPm.lSN4vmna
vervicol
Authorization for Cremation and Disposition
This AUMOr ffm Form meet be compNNd alit lianed prior to del newly of mma ins for cnmal
Dam.OW1412ON Number IO1 it
Crwrabry Name done V Crunalwlum
Morass.0uaker Re-oueeleburY. NY 13BM Photo'. I IIE-N9
CREMATION IS AN IRREVERSIBLE AND MNAL PROC1l
Cremation is•amend ON by Audi the remalne OI Me mu d and the cmlairer lmNiry Me r im Into acx don Mao er whom
May am subjected timely heat and Same. no Mal and Bmm will lnclnerab and Consume ewrylhlng sxp tom and ms 6,
aTlch am all that will be left aXa courromn.
FOIIOMnA cremation, me wmatery will mice reasonable ettons he remove all of Me remains and other maMMi tram the assumed
chamber.but some minimal seemed resdue will likely be left behind The cremabry will separate Inddental and foreign mommusl Imm
tire remains and Me madams and fiderl maknal will be dispose]of as reall bylaw. The crewW mmaina mM be moG niW
pulmriud into small places and plawdlnb a model mtmimr Or am. Cmmend remains9emnllyampulvM until no
single fA lmm Is reao9nmbbe as ablaml discus.
OPENING OF THE CONTAINER
The aemamry may only Ccen the container holding the unoemaled human remains In limited drwmatances,such as to mnfirm the
idel Medemased Seto ensure that me mineral is enGmed which hall Injure emervaroe drdemege Me minatory Prop . N
human remains are dellvnd In a corminer which Is not milable Far cremation such as nnmonkl wmnLLl mks,the
commodity will require share the mnvins be moved Into a suaebb conful tables N accept Me remains, The olening ola
mnmmer or the transfer 0,removal 0l remain Mk be conducted Wm a witness and NII be done in pnvary,with dignity and mama.
DENT NCAMON OF DECEASED
Name N Deceased', EWnm MWiscmr Malty eater:WlWand
Iasi Kronor Address:319 Bmadwry, Fan EM , New York Issue
Pla¢of aal 319 Bmadmy, Fed Ed , New York 1R28
sex: IJM IDF A" 90 Cold:OW811930 Dafe eta M:OWI=20 Eebm.Ma wely+c IIbIM
Dearentan of mskWwM Win wTIG remains war ba reivvM.
Matthews Casket Co. Cremation Case -cardboard top, plywood bottom
PERSON IN coNTROLOF mapos l N
�(P�MyrZ�(s)in wnlM of olspw.ibn lLlWor ONE Or Ma rdbbow;
mNJn are the designated seem of the d asad deeNna In a as 0r wnital imwm t axxumd pweuanl m Peak
HealM Law section 4201.
WMe havens knowladae that Ma 0eae0eed exewred a wren Instrument Farmers to Public Haiti Law aecl'wn 4201 or
wSl amounted dlmtlilfor the dmposmon a he or bar remains and lM are the perea lal hemng Seems under Public Hwl Lew
SedXn 4201 and have the right to authirl direction ante remains stMk1d�eewawd MylO r mlaYnnahlp w Ito demaved Is as
holders Elean dr VXay Fischer
DOslcg6f oury,dead) mwowma Pape I a]
Authorization for Cremation and Disposition
(11 mid lmm Na an meow)
Nunni e& Comp t ` 0 ✓I
1. Amrson ee9gnatM In wmNg pull to Public Health Lmv Section 421
2. The surviving oppose;
Mu The gowning pomade[Pam"
3. My sunning card eghlmn ram OF ago w dtlxi
Al A surviving parent;
5. Aad saying YWng aightwn seers of age 0r older
S. A bwN9y eppante]gimi ni
2. Any"mon181 agaeen years of age or older Omitted W sham In the estate and who Islam dosealt in MeeonSap To Na de ASW1
9. Aduly appointedMocary 0l Me her
9. Adoss Parent Orma ewrap ham comical" a whitles abnormal Pul l m Public Heats Law Section 4201(2);
al Atllref 6¢wl OHimr 0l a county or a pi aOminpuralu generated pursuant to the Surrogate Court ProcNura All
TO& My WMr pawn who is acting on Nebel ofMe"re0 and who had elew dawomen tlaloment rural to Public Heugh
Law Semon 420117).
(�lyppp�yFA�9/LL�L THREE iM ngl lowi
J !fl If hereby aRrvrn that the body ofNeMiami tlms not cone"a Ntival battery pack,power full,radcacuve Paul
or radioacWadevF.08nd Nat airy¢Ich mBknYe wen rpraveE ylorbllreaw[Nion d Ni¢Aullrorizatlon Form. Fellum to rampw
these Hems prior to cremation may roue In halm to My mmaI and cmm Wq g we .
41*1INVe dorm that lmVuclims have been given N Paul M. Didrcb nn
mgaming Me removal ofany Pononal properly a other Ming M value which any person signing mallow or a"buds IMmEer dine
d and wishes to proerve. Pine Yew CremetMum
is slot responsible for Me renewal dpswnal items from Me contalrcr or"in Me remains of Me discussed. Psmonal erns Its to the
YFto9 or with Me mmal no w111 be destroyed by the cremation prom M s and cannot be maved after um ealon.
ate'/(v Me hereby,auMONae Pine draw CremBMfium meow
m annual I margins d the demo .
(Ins=1OFT1ONA4
May herby autholae the named Iurmml director to pmvma par delivery to antl cmmdlon by an alnmal
matery, edn mx ss d necessary In the opinion of the fumnal drmgpr and W amantl arm fan W govlda the comtl arms and
dad mug W such allmal Congress.
FINAL DISPOSrtION
The person aNhmaad to r ,a Me crenated remains of 1M defused tom the c am l9
Nam:CNBbn Funeral Home,InC.
Addi 68 Main St., Hudwn Fare New Tam 12639 is 51520/243
nauemeree YalaaFt0 d d¢ & s 1�m �^+
7 nl `� , L�� �c 4
I far any reefpn tiny war main"above din for ages pwe"a de»emasmd mmam:
Pins Vow Cmmmum yBNM dW give p Mion of
Me mmaMs to C"don Home! Home,Inwaw by Mail
in person or by Wsbred mail etw boar
My1896l(Rw,tourist rr� Page 2 of
Authorization for Cremation and Disposition
o�bed theb mwmnl
ei/ may understand that x 0a remains are nW banned within 120 days W aemase,
Many vex cremmndum may d spOrs a the remxFam
tlee yl
an nrman e oele manner. aw as by e®ay dr .
CREMATON CONTNNERNRN
andil OBE An the btlo
/ An umber us urea eaemmen brbe vemalM bmeim Nes Eeen pmcNead lmm
ta a
and ladescdd blbws� PbPl CIO ob-tlJ H LTC
Me credential met f the nm 'a No blood her hold the antie crammed rel an actuieorsl l barrel may Na used Matrmry
.OR.
An um 'w M had puM , me uldWyNUW met It ro um la purchased m MMrvmepavidaE
Pine Vim'GmNMum wan place the uema ed monsam In
a read bmperen thermal for me".
They AmborFeaan Form was puegN by Paul M. demch wu emcNed W
Carter Funeral Noma In a�,uwovrew
Oil @., Nuaon l sis. New"ta 138}9
ens as aen.a er me mmrel darenor a.wmne m In eeoMon��
IMe hew rtaivM a completer they of this Authorization Form.
The pamrms)meta tl Wim(Ware tM Porsoniel in mntrol of dequa eo.who by tlO nine th is A UthanhW nFarm,aXeagQ
W the acwaary and eamemenoof the Informal conblmd In Uses Authorization Form and aWoorma )me forinig.
O Y dm 14 day of .Sep
Sao
SI Na ��
c... rw n A PA Gv 4J . {df 1dV 1787 St
WITNESS:
Paul M. Drawn
10M Ek Mes �y%mwr
DDS 100&f(Rev.Carl Pepe 3 W 3