Deuel, Karen Pine View Cemetery g Crematorium
Quaker Road
Qaeensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: ep� �
- ----._-_... RETURN TIME. _OgTF 6 TIME REMAINS ARRIVED AT CREMgTpgy. 9 F
So
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
apt g
NAME _
--- --
- -
- - -
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_..--.CC1�FU. lhy�C _ ---
TYPE OF CONTAINER _. J-/j /� - -_ CASEM
UvE
!� - 1: II F% - f N ivM(•PLACE OF DEATH: - In flF 6 M
64
ESTIMATED WEIGHT OF REMAINS fl CONTAINER _ I'
PLACED IN HOLD: 16L_-561
PLACED IN REFRIGERATION: -_ -�-DATE OF OF CREMATION
TIME STARTED:
p � TIME DD 2 $6 F-�
PLACED IN RETORT 1 161rV _ �
RETORT IN WHIGq REMAINS WERE CREMATED: - q��
DETAILED REASON FOR DELAY IF —9�— -REMAINS WERE CREMATED MORE THAN yD HOURS
FROM TIME OF ACCEPTED DELIVERY
NOTE.. THE TIOSHALL
CUMA
5 ll BE RETAINED xinEp ENmnxExT FILE Or THE [veamovY.
DN OF
1a1RIM
NEWYOKK Division Of omsloN OF tFHE1FRIF$
0OFF F
�° °" "" ^ Cemeteries „12"- 01
IDMp ea:w c4dail M
Authorization for Cremation and Disposition
This AMMO Non Form must W completed and sign" prior to 0manday of m Wm her cmmedon.
Data 9/1 M020 Numter. /021
cemaory hare: Pine View Crematory
Quaker Read, Demurral W 12804 516745d477
Mdrms: Phone:
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremation Is rarietl out by plating the remains of the dismissed and Me mnWnx hoping tee remains into cremation Bull Mere
theyarewNWM tomrenseneatand Y,are. The Iwtand Move well IndrwebaM cwleune everything ea thane and maps,
which are all Matwill by left after minimal
Following vemabon, the crematory will lake reaemede eRord to remove all of the remains and ether maternal from Me uemation
chamber, but acme minimal dust and resi lue will likely be left behind The Yemeni will separde NCNnnd antl foreign material from
the remains and Me IrcideMal and foreign material mil be disposed ofm required Wow Theuemak remand MilbemeManV 11
pulverized i smell proves and placed into a designated container w um. Cremabdmmainegenamikan Wlw duMim
alrgh fragment is recognizable as skeletal Madrid
OPENING OF THE CONTAINER
The vemalay may only open the consumer holding Be umvematml human remains in limited mummstances, soon as to confirm W
NMMy ofMe reveal onto aware that no maMdW is mathand which might injure employees ar damage Me rsemeldy pmpery It
human remains are delivered in a w inxwhzh is not suitable Be cmmatlan such as department or moral w2k the
meal will RgUlre Mat Me remains be moved Into a mode le container beorre it accepts Me remains. Thecoming Ma
container or Me transM or removal d remains will be conduped before a witness and vnll MMre in p,tvacy, Mth dignity and rapwf.
IDENTIFICATION OF DECEASED
Name of Deceased. Karen Deuel IdariMl Slam: �Dw�
Last Known Address 11 Links Ave., Hadley, NY 12835
Place of Coach Glens Falls Hol Glens Falls, NY 12a01
Sax: ON ® R Age:-7 LDOB 101tq I Ig 4b Bale a Death 9/1lW020 Eppmatm wdght. rnrc
consu on INnekelkp ner in Mich nmLns vall be deliverer.
McDonald basic cremation container, no interior
PERSON IN CONTROL OF MS ITION
tparaanra)m mvrd a eesppsimim.�QHE d ma rdmwingl
I anvwe are the downgraded agent of Me damamd designation in a will or ml instument executed nomasad Publk
Hadth Law Seeon IND.
1 -OR-
it � y�'�
l- lade have nor knoeragethat the tlemRatl Accrued a rnMn samurai member to Public Damon Law Sadion 0201 or
will mMdning drea0n8 for Me dispeYticn of his or her remains and me are Me persomill having priority under Public Health Law
Se n4201atehavethengMWauM emmahmMMeremainsMeredxaAnd WMurn onshlp Wt der<asdisas
bllows'.
Karen Deuel
WS-1808-!(Read.08115) Page 1 of
r
,Authorization for Cremation and Disposition
l�Me mvoaa+N
Ol ' iunderstand that if Me nomaln9 are nM earned evil 120 days N Cremation,
Tina Now Crematoy,
mar dispose a Me remains in
an imamawMa manner. soon as by amgeo-9. ✓o«Mo-n
CREMATION CONTAINERNRN
(Inu ONE of the Memel
An um M M Arm as a mnminer for the cremated moral has been purchased from
aM is Mitterrand as hall
INJe understand Mon If Me um is tin smarl to hold the eriare uemated remains, an id animal rigid COrdaine may As mad for street.
1 .oIR-ty�
7( i1LLI-M um is not yet PoronaaM. 1nM understand rc a erstana tat IF am «aeM oMwYae providedPi Are New crematory
Pnedc"re ry ll paw Me IXam91W RTab91n
a said temporary mml✓ar Mr delivery.
The AaMwieal Form was provided by Patricia Miller was eawAeY at
momminei
Brewer Funeral Home, Inc.
24 Chosen St., lake Leasing, NY 12M jeiYNnsN 's)
I 'Nwrr and is signed by the formal directe as smarmysmarmy bib execution,
li hove moeivet a wmg00.N Copy 0 gas Abashment Form
The persoms)IdemMd below ✓om Me pesom✓In wenbol W 6epmition.and by signing MIa Authorized" Forr at gs)
to Me atturesy and oCmptaten oI tray Information Wnlvinsd In this AUMomal Form and auManole)Me lmpoing.
st rma MN 16 : September p 20
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—Anrr a r �t \�n min q (� anvn m
r I Trnycr Sf. G Inns ka I lc.�j! 2P)
w seem
WATIMESS
PLlsda M
Miller
rw+dmvw..m in�m LlW11N
121W6
Karen Deuel
ooli-lem-1 met =1el Page 3ai
Authorization for Cremation and Disposition
e
O�fOwn me uw nakw�
Number 3 Lee[rtpnon: adult child
2. Treurvrvwignated in sorting Punuanl b Pugn front Law SOMM gpt(3):
ng om
]a. TM survival domestic partner;
O AA6sul Chid algM1krn wean of age a over:
arri
S A wrvivi g parem'.
a A rp al eighteen years of age or Older;
bwll PPolnled guardianl
]B. A baby' Any persons)
appaxnagreement fiduchavy of Me years Of age or Oder entitletlNsnare in Ne estate and who it career N seasonal to the demos
9. A Come Mend Orreletive xlro trgs eaecbul¢da wrillfn &atement 10. A Lielfialll efisr of a county or e Public ecuded aminislralmeppn1Nauem to Public Heal Law SeClion 6201(7J;
toe. gnyaMerperson wfimbationse
a is aciNond SK&Merleceaeedandw haserreloWaw to the lri "emous"ma yuregc;
Law Seyw 4201(]I, pursuant to Public hensup
* ((IP&y1y( MREE OF Me hgorwOg)
(yI.IL Man hemby affirm Met Me body dMe demai dove not wntaN a owners Marys
ry pei power coo, r.aioadroe implant
or andopo Ve dsvic¢and Mel anyauM mal¢rlalswere removed piano MeexeWlion angles AUMMaatlm FOM, FiilunbremOve
M�wyytt�ans prprb cnmaEOn mew raeult In Mrm fO Me cmmabry ant[rmrrNOry pemOmal.
� IAW eMm Mgiorml have peen Pal MIIpI
given to
reyanding Me removal M any Marshal papery,or Other thing W value Will lr M person signing bebx ae kmll Finial New Crematory ^Y YmemMer Dints
tleceaced wbder topreserve.
rs rare reapenade stable Iel l ofpersonal items from the container Orlr�an Me rcmerm of the debroed. Pononal Mna MR1n 1M
COOnhebw w wiM Me maim will ba Marsha e l by Me orientation Pm me and canml Ma retrieved 21 cmnaffil
IL]L =1Mb MRM Pine New Cremalwy
y euMnrtre
�w
b CmmNe Ma rwnelM Of Me decreased.
F
IN pertm aumoked to rxeiae the cmard i d remains Of Me der¢ue d 1nT Me oynelay ie
Neme'. Brewer Funral Noma into,
Ad0leas'. N LM1UM SI., Leka Luaem¢, NV 120iB 5188pe.2]N
phone:
IN venuvd remeln of Minimal win be disposed sae ingal
b�- tL{X ak Sctna}off �lzaxa.( Cna�tele,�e�
PM
ltem nllw perm n.medabve tice.mrdkeNweainaMeawreled mn.vu.
Vyx Cremwwy
a auMaiead to the war ova
IN remairub Brewer Funeral Nome. l��
m«wava.wl by delivery
In person or 4 registered all
Karen Dauel
sw
I%IS1e95-rlan. /1M Page 2 a3