Corseti, Stacey Pine View Cemetery g Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (518) 745.4476
FUNERAL HOME: -,____�v .^C- --
/I1. "-"---._..-.,_.. RETURN TIME.
04TE A TIME REM --- - ..pINS ARRIVED AT CREMATORY:
NAME OF FUNERAL DIRECTOR OR REGRISTEREO RESIDENT DELIVERING REMAINS.
NAME.
TYPE OF CONTAINER
PLACR OF DEATH: , 5
ESTIMATED WEIGHT OF REMAINS S CONTAINER
I
PLACED IN HOLD: - vD
PLACED IN REFRIGERATION;
_-- Z
DATE OF CREMATION:
TIME STARTED: --"'"12
- --------- I—�y�1,1-_rlmE comvLEreD: JZ.__
PLACED IN RETORT: ff0A I6 ' }O�
-- MOVED: __,' I
RETORT X IN WHICH REMAINS WERE CREMATEM
DETAILED REASON FOR DELAY IF REMAINS WERE CREMA� -
FROM TIME OF ACCEPTED DELIVERY: ED MORE THAN 46 HOURS
NOTE: TxECREMATION LOG SMALL ._-- _ ..--� PeRe♦ RTxE rERMERm OF TNe CREMniORY
now nor Sri.
ZlfNEWYORK ory Oo�r"ems
for Opp I Division of "one` eoee,e
Cemeteries .wmd..n_p.ma,
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Authoriration for Cremation and Dlsposltion
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CREMATION
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Authorisation for Cremation and Disposition
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Authorinflon for Cremation an Disposition
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