Laramie, Richard t'I^e view Cemetery g Crematorium
Quaker Road
Queensbury, Pry 121104
(518) 745-4477 or (510( 745-4476
FUNERAL NOV.,
DATE A TIME REMAINS ARRryEU AT CREMATORY; RETURN TIME
NAME OF FUNERAL DIRECTOR OR REGRISTFRE D 1L
R RESIDENT DELIVERING IVERI ERIND REMAINS:
Bo"JAv—
NAME "--
-_ . RrGyAmj
CONTAINER,
TYPE OF _. -CASE 0 p
- �II E L � �---_
PLACE OF DEATH: ,_ d 4,
EBTIMATEO WEIGHT OF REMAINS & CONTAINER
PLACED IN HOLD: __ lYf 4F'.._yLYcfb(
PLACED IN REFRIGERATION; --- -- ---"--�--_.
DATE OF CREMATION:TIME STARTED: _._ ppft- _- _-_� pp
_TIMECO E PLACED IN RETORT11 "- r�
RETORT 0IN WHICH REMAINS WERE CREMATED,
DETAILED REASON FOR DELAY IF REMAINS W EgE CREMATED MORE THAN
FROM TIME OF ACCEPTED DELIVERY: AN AD HOURS
NOTE THE CRLMATIOx LOG SHALL HE-- - -- - --
NI York
Department f5 b
STANEWYORK Division of DIVISIONwmy'°,w CEMETERIES
°'PORT""" Cemeteries "
w 01
waack"a22d
Authorization for Cremation and Disposition
This AuMa ae Form must he C=pN d and signed prll dalmody of remains forcmme8on.
NW 0&ly[020 Number. /OZp
Clanamry Name Few Vex Cmmamry
Address 21 Quaker Rued,CincinnatiNY 12801 phone. (518) i<SMTr
CREMATION IS AN IRREWRSIBLE AND FINAL PROCESS.
Cremation is dMwm cut by placing rite remeina of the de and Meg Iner holding Me mmalrs into a uemation chamber v M
they are suNmi m Intense Mal ale flame. The heat and Game wil11MIrerNe ale consume ewrylhing cannot babe and mNl,
match am all Met all I he MR after cmmaon.
redeem cremation, Me usua ay wM time reasonade ercMa b remove all of be remands am other mattnal from Me demanded
chamber, but sane inamat dust and rescue will likwp be left behind. The Wmatary win separate Imidemal and forego mffiml from
Me remeina eMMe Inptlaruel end foreign material will be tliap08etl Olas Relined ay Nw. The uemak remains well be m% aniolly
Wbxnaed into small Beres and placed into a designated m=iiner mum. CremaWremalmg llyarepulwdaadurim
singlsmWent Is meognlaahle as skelN i aasue.
OPENING OF THE CONTAI NER
Thee tay may Only men Memmuinermolalng the unermnaled human remainsm limited circumstances, such wito confirm Me
Identlryol Ma demesed arm ensure that no maternal a mandate which mi0htinlureemployeea ordmnager Me cRmalaryprOgry. N
human remains am Gilwr In a container whadh Is rat@unable forrnminent such as perm it or metal uaWS Me
Mabry will ra ulor Met Me mmu lns be moved lama Bumble container Were it acupY Me mmi The CWIIrg Of a
mnpurk r or per Oanabr or removal of remains van bemndaebd bNorea xi sso and al M time In a w o w0i dignity ale respct
OEMRICATION OF DECEASED
blame of Coaxial Renard leremte MCNel Status: MCMed
Lazt Hnwm Mdre 10 Plum 18M, GaM9mOM1 NY 12MI
Plagof Ockath Glens Fells Homer
sax: O M [IF Age: 70 DOB 03/08/1950 D BlO lh 0"Ano2D EOM YMOM
Deaadpllm of gsxemontamer m belch remains will to deny ed.
Cardboard Box wNVooden Base (cr-M „e l(.,$ ,�{
PERSON IN CONTROL OF OISPOSRIM
(Po5m(4)M mnOd or Gapwitloo when ONE an Me Mkmtirp)
I amaki are had desgna agent of We Mgewtl d"igna In a will or n nNmeM eaecutad mounted m Pulp
beats Law Sec4m 4201.
-OR
rup
'A dic was haw no knmNNge than the desalt ommde] a wMbl In401ane11 pr4uemm Pudk Neanh Law Sappon Q01 or a
will command tirecOa S A,Dan ciapmter of his a her remains add Was am megreOMa)ranked pnonty under PuMlc wall Law
Sedan 4201 and have the Night to suddenly cremadm of am romans 0f Me d�au . Mylcur relationship mMe decsased Is ee
follows
Richard Laramie
DOS-18al hima Car Peg 1ms
I
Authorisation for Cremation and Disposition
rlwawf M1vn the Met blow)
Nobel g Otheophon: Loneine LVamb($pouae)
1. Aperson described in wrong pmsuam b Pubic Health Law ion Pm(3)
2 TM wrvrvirg symna,
U. The sunirving doneauc peNar
> My¢u rvInO UIIE ei0hmen Fan M oOe by dEer',
A AsuMNng parent
G Asurviong siblirp egMeen years M Age or alder
S. A bwWlly appeal guardian:
T. Any"Pron(e)immense years Of age or older enMhd W share in fee drugs also xlm lead tloeml in Wl onMp W the Mma¢e1
3 A d derreeYva redeem has eo
9. A dead
adfriie um a wren skkmenl pursuant m Public H M Law SeGOn 430161
10. A chof facal all of a county or a pudk administrator appeal pursuant to the 5urt0yds Court Prcwdure Ape
IDa. Any other Person who l¢atlira on behalf of he Oemeu0 and"ahas executed a wren sugdmNl pu9uel M Public Hanson
Law Send,0301(7)
nmfiel ALL MREE of Me mouni
al And hereby affirm that the baby of 0¢Oemawd ants me con(am a battery, Mtldry pace power fall mdiactive implant
Ormyi08G(iy tlrv'M dab Ntl any each mdbriale wed remavetl piOrm Ne Baecution mots AUNorhefM Fomr. Falludbmnove
aid d s*Items prior M cma0on may resuN In hams admn Me caWry and cmna pd oonnal.
api IMb inner that lna0uctin¢he" been givenW Rollland G. Head
regarding the removal of any personal pyderry or othar thing of value who any mon on during baby,or any fill member Of Me
dereeaed wlaMa M Penney Pone Ndx C9ermay
9 n01 Reponaibk Mae RmW810(g90nel Mm9 kOm Ne WMeNer on kom the remains cfthe deceadel Nmmsl Mme MN In Ma
conmmer or with the remems hen M&WOW by the cmnmlm p me and canna M Ransil after cremaam.
44—PWe hereby aNhorlxa Pine(Mary Qamalwy
W cmnW Me contain dMs daeaeaW.
(MW OPPONAL)
my, Mr auMorva Me named Nne91 director W provide for delivery W and cheat rn by an aMrnate
m 0q,Ndw necessary In Me opinion ofthe Wnedl director and to amend MM from W provide Na correct more and
address OFF such mandate cnmamq.
FINAL DIS O31TI0N
M T damon authorized WM iw the dented nermu a Of Me MId88ed lmm lab aem=7 b:
Name: Compassionate Funeral Care
AMA. MW MaOk Ave., MrmoM Springs. NY 1P Mme: (518)Y4LBeC
TM umieled remains Of dewaddd will M damrsed of as .
RETURN TO FAMILY
N fw my mu and person need summer dean not may yw¢seowi of the oe remams,
Pin we ,Cremmory wmov¢edbgiwryWre'Mrd
deer onto ro.i.mw,..r CwnPx MFure Cam, led ofassu e
in Po9m Or by"amend mall. a+eawmusxarx Rg9M Wems
Panamanian D0S13m{(Rev. O 20) Path
Authorization for Cremation and Disposition
MPestywe dissident)"
4! Malay under¢Rhiq Net if Me rtmams are not canned wham 120racy¢of demanded,
Piney Crematory may deal W me metal in
..damn
an inlda all meren, Such a as byinnedp.
a
CREMATION CONTNNER M
IL ONE dme bpevno
M um to the used as commircr For Me vemat to remains has been moca rail from
aM W awarded as bellows
Wh inWntand Nat it the Me se hand smell b had Me same Ge smadiar an addhonal XBb container may ba used her delivery.
-0�yR-pp
¢)a�M um i¢nMyM WrcM1aNtl INJa untlarabntl Nattlne im'u WteM1eNd w ONe�xi9e proMed
Pine View Crematory will plc¢the cremated remains in
a mild kmpaery comalner Mr Money me,mucmmrmn
This AUM atlon Form was provkhal Rolland G. Hong was emombd at
Compasaonato Flames Can, Inc
W3 all Awa SantoOa Sprii NY 12M
add a signed Lytle M1menl dirxbr m want me ereaN n��
IMB laws mMiWd adeal may V Mrs Anewhaaon Fomr.
The paraunls) Idend Wim Isla m Me prwnlst In coastal cl dYWSNon,"a by sign6p NI9 AWaa wFmm,aftsi
to de accuracy end camplNness oftlie Immora n contained! In Ran AvmmimtW FOmr and auModeds)te bnpoLp.
Slynetl ads im dayof SeptemEer p 30
LwniM Leall
r10 Film Iere, GeNauaamL NY 121131
apecriarmaverat
v °Pam
trlfrXE94:
Rolland G. Hop
Duey Mnvnaatrsw ve m soil
838
Restated lamaNe
mM1S8"than,01130) Ppeld3