Nash, James Pine VIeVV Cemetery & Crematorium
Quaker Road
Queensbury, Ny 12804
(51 a) 745-4477 or (516) 745-4476
FUNERAL HOME:
RETURN TIME _
DATE A TIME REMAINS gRRIVEU AT CREMgYORY: J
NAME OF FUNERAL OIgECTOq OR REGRIETEREOSIDENT DELIVERING REMAINS:
- _- -NEV6j, -POW..N _ .._H RE
NAME --'--'
-u�t�s_ NgSN _. ---
TYPE OF CONTAINER: - - -- . CASEX 107.7
PLACE OF DEATH;
b
ESTIMATED WEIGHT OF REMAINS S CONTAINER
PLACED IN HOLD - /51
— -
PLACED IN REFRIGERATION; --
-_
DATE OF CREMATION: �—
TIME STARTED:
_... I TIMEc COMPLETED. _ 794tl
PLACED IN RETORT _ ';ll(yyl4 MOVED ,-1 CR Qa(0
RETORT PIq Wq,OR REMAINS WERE CIIEMATEO: � �
DETAILED REASON FOR DELAY IF REMAINS WARE CREMATEO MORE THAN D4D1HOURS
FROM TIME OF ACCEPTED DELIVERY'
NOTE THE CREMATION LOG SHALL DIE RETAINED IN THE
ER - T _
Raw yo,k ante
OepetbnenlNSYY
KEW PORK plVls1011 Of IamslooOFCEYEleP16
sera DF one CMMPlere
a 7RCTY. Cemeteries q,,wsomles iy;;°;.�,
Nape,m pilq(H6tM
aim on,cam
Authoriangtion for Cremation and Disposition
ThIe Autl RM Form meet be completed and signed prior Y delMry OF remains her cmmadon.
ute: 0911612020 Normal
Cmnamry I& Pine View Crennumurn
AddmY.51 Quaker Rover. pueensburri NY 12804 PnYY: (518) 745h of
CREY MON 13 AN IRREVERSIBLE AXO FINAL PRMM.
Cremat'nn is tided out by placing Me remains 0 the d add and the smother holdingtM remhNm into a vemation Wnbx Mwa
they are subjected Y intense held and flame. The heat and Nma MIN I=IMMW and consume eraryMlne @xcW tense ant meW.
which are all eW will M laid Bear memories.
Following cremal the chiral all Me Rasonable.Roos to remove all M the remains and ClMr ra9tarial hen the veme m
chamber, bin some minimal duct and residue will likely ON lab 44Gnd. The uemepy will sepemte mader al and breign minimal ham
tM remains and IM inpderml and Real material will be dies OraeMired bylaw. ThemmatMmmnswiyMnechnkly
pulvenzed meant small pews aid placed into a designated co mover or An. CrenYbd mmalm penarally en p iv one rq
single lngmea is reaognlYEle as skeleton beaus
OPENING OF THE CONTAINER
This,varneWry,may only open the container holding The unUemNsd human themes to limited nrcumaYnus, such as By Wnhm the
teenyof Nwde asedorWensurethamomaterialmendtt wOmgm InjureemployeescrdamagethevemRwyPMcry H
humane im am dell" In a corminer which Y nRaubable for cremation such"mrsurn lOr mn%l"Rat,Me
mebry will reguln tlY1Ma nmvins tea moved InM a sulbbla conYlnR MfoY X oCCaINs Ma mmelm. TM cpnirg old
WnMiner m the hanshror removal M remains MII CecoMude] belY6 a xilreK eM will Mtlam in IlriveC/,wild dpnilY and MpacL
OENTFICAT ON OF DECEASED
Namem l>eteaead: James Nash M4Mletebs. Manied
Ln Known Aedmal 10 Buena Vista Ave, Qg sbury , NY 12804
Remo Dealt.Glens Falls Hospital, 1W Park Shamir Glens Fells, NY 12W1
aea: ®Y OF Age: 86 Doe: 03IO2/1934 pant of peaM: Og114/2020 ENMaltivYkya:J.11—
OsheronofneM Miner In which mmem Ml be dNlvRed.
MaRhmws Corrugated Cardboard
PEReOX XCONTROL OF INSIM IQU
(PemwNN m mnhd dWgeNiarr. ONE d th hMrMrgl
1 argil am Me d"gna agent of the mmewd dpgmted In a wall or wismn InYrumml exerted pursuant to PubM
H htaw Sectim 4201.
R
I/We have no survival Mel the mode d Beatrice a vmthnInstNmenl pursuant b Public Rival LAWS M4201 Ora
MII mnYmirp d'mceons for the dissolution 0 his or her Ymain ,and pares art The mrva la)having Frailty trade Publk HmM Law
Se:Hpn 4201 and haw Me ngm to commit cnsul of the remains W the eemased. WIWr nYNomhlsW As
M vx :
James Nash
Wei(Raw. 0420) Pepe l af3
Authorization for Cminatlon and Disposition
(Wren too woe w)
Number 2 Description: SPdl
1. A person designatadin wine fomented grow month law S 4e01(3):
2. Tas nrvlvine spouse',
L. The surviving domestic Penner
a. Any surviving chat eighteen years N age or Oscar.
4. A summing parent'.
S. A survning doing igMeen years of age or older
6. A grand Ily appointed sueNies,
T. My morma s)nghteen"am of age or OlEer aitled to sham in Me eMb and who aware sowed In raWOMhip or Me NxeW:
6. Aduty appoibled Mo[Iery,of the estate'.
9. A dose frets or regrtM who has araWb] a wisdom signal as moms W Public Heats Low 5aC40n Q01(7):
IM A chit goal officer Or e county or a public administrator ayoal annual W Me SunaeeR'a Ocun Pmxdum iq
1W. Any other pereom who 're aQingm behad W Me dewaeed ant who has executed a written statement pumwt W Pi HaaM
Law Seim Oast(T),
(In ALL THREE on'IIro WOMM)
ii / YWBM1eROy eMrm lnel the bodyaMe deceeNd does tat contains Wtlery, betWry peck parer Wll, redimide lmpbnt.
or 2dio6tlw Simon and Mal any such mMNls were recorded phor W Me BreN40n 0 tnrt ANo*h Form. Failure W cot S
Mason Itwp prior to cnnmllan may mutt In harm to Me cnormal and ch mNory parsonni
// /1' IANe affirm MninaW tine nave been from W WendvM Bunch
regarding the mmovm of any personal prepeM or honer thine of Valve whooh any Person signing blwr or any fomly,r Ofte
demand wishes W pnsem. Pine View Crematorium
Masashi
a not responsible for Me removal M personal Items from Ma container or Pon Ma remains Mten demand. Penbrel Nmo NM In the
conterver or with ten rhmalrvwin be dutroyad by the contends prows mind"mass N moral after Cmma n.
// IV mMrebyaw a Pine View Crematorium
P�+rvx.w mcnm.m me mmeln a"MCerm.
rfstIf OPTIOri
LYe nemby nomination floe named funaral director W provide par delivery to and cmbWlon by an slmmm
«corny,
chambers.
n doubt n in the opinion of Ina wnam m l director and to omand%In farm to pW Vlde me correct name and
oddme N such alas CMM&Wq.
FINAL M$MSMON
The Power embargoed to mmne Has awarded renoins M the meadows Mom Ns vemelwy is:
Nam:Singleton SulllMan Potter Funeral Home, Wandy M. BDlich
Aadraes: 407 Bay Road Queenstril NY 12804 PNme: (518)791
The aemabd rump Of Mwaead will be di of Me blbxs:
Return by family
if for my wars and Mu resod ebm dw not tots pwemidn atle aemebd MWM.
Pirm View Crematorium Is M16mmd to glre posnnlm0
Me remana W Singleton Sullivan Potter Fun6ml Home by delivery
ncemonwby reglatem and, Jamaica Noah
p`wa�e
DOS-hill(Rev. 0400) Phil
Authorization for Cremation and Disposition
rtilrYme cdow;ry
uwe uodenaM drat dine rem.im.re nmealmed armor 11t1 days aamauap
Pine View Crematorium rrgyypppapWge mmyu In
an lnablevabk mentor,ever,as by scettanre. ucw.rwx
CIUEaATIOM COWMNERNRN
fN�l oNE dine aww'rwl
An um t0 ba used see Reserves for the unmated remains has been purchased Form
en0 ie 45MpM ea blWwe'.
IAhe undeMeM thud 9 they um is tort amell to boN the OMre onametM remains, an naiional rlgilpMrtMr may M used For dM ..
x�y Ash an is not W peMue]. Me wgerabnd that If her an as Wrc aW or otherwise provided
Pine View Crematorium will place the cremated runway in
e rhad amdenery container he dNNery rre«✓onwnt
min Aogad w Form was needed by Wendy M. Bulich was exeaad at
"Wei Movies
Singleton Sullivan Potler Funeral Home _
407 Bay Road, Cueensbury, NY 12804
'viev,swu and byVI by the Nneal director as wit cwon ness to its exe
been have reeved a completed copy of this Authorization Form
The rynongl Wa WMlow iWare,Raw"recnp) In control of observation, who by signing this Authorization Form, a"eaysl
M tlN accuracy and compleeness oftlx inform coMlr In thus Augonze0on Form and authstoei the foregoing.
aypadgy 15th days September .20 20
Reaar Hannah H. Nash ..-� o/u vl
10 on a v
BuenaBuen Ypta Ave., dueenabury , NV 12804-
w
WnNE9a: /J
Welly M. Bulkh
n.m,ra.esm.arww
10441 enreenewessi
JamesdurnmNash
aa�awo....N
DOS-1098-1(Rev. ga20) Frapi