Nelson,Margaret Frances-Brand Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME:
.__..___._._.A2tnNDEk--
__- rserursN TIME.
DATE & TIME REMAINS ARRIVED AT CREMATORY 1
NAME OF FUNERAL DIRECTOR OR REGRISTEREO RESIDENT DELIVERING) REMAINS.
_....__ _..._- -➢NLt *"pFit_
NAME.
TYPE OF CONTAINER - -�"--
too—
PLACE OF DEATH.
-- 1
ESTIMATED WEIGHT OF REMAINS R CONTAINERS
PLACED IN HOLD: - - -tom '- / ---
PLACED IN REFRIG RATION
OpTF Of CREMATION TIME —_
_. 9�Iaohv
PLACED IN RETORT.
STARTED; _- $j _TIME COMPLETED;
PLACED N )0�
RETORT q IN WHICH /D
REMAINS WERE CREMATED:
- -- w ' -�
DETAILED REASON FOR DELAY IF REMAINS WERE CREMgTEO
FROM TIME OF ACCEPTED DELIVERY: MORE THAN pg HOURS
NOTE. THE CREMAHOLOG _ —..
F'EL qE RETAINED IN THE PC
I'MAMENT FILE OF THE Cn EM4TOgy
oM Stitt
Department W,fete
—J NEW VORK Division of pNISI�X OF myauk1ETERlls
of
° Ty Cemeteries Washrwmswmre
NY rcam
Twmor 51e47"226
riaccuumary
Authorization for Cremation and Disposition
This Arrowheads Form must Oe completed and signed prior o delivery 0 remalrn for mmatled.
Date: 091082020 Number [oil
Crematory Name: Pine Yew Crematory
Address: 21 Quaker RE Gueenabury NY 12804 Phone. tall) !9^I1Ti
CREMPTION IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremalbn is caned out by placing the remains of vie Caressed and the cone rat,holding the remains Into a cremrten chamber wlre2
May are subievied fointense beat and name. me hen and ears will Inchmeram and turn.everything seemed bar»end meta,
which are all that will be haft after cnmauon.
Following cremadon.vie crematory yet take reasonable shone remove all of the remain,and other marmal from Me uematim
chamber, butmme minimal dust ant Reldue wal holy be left behind. The comamry call separate actual and foreph material horn
Me remains and me incidental and foreign normal all be disposed of as required by law. The aremamd remains will be mechanlwny
Inimical small pews and dacM into a dealgnalab container or um. Cremated remains generally an pulverized until no
single fragment is recognneNe as skawal tissue.
OPEN NG OF THE CONTAINER
The random may only dean the belainer holding the uncremaled human remains in Iimiand Grcumsmnes. such as to m mtM
identity of Me stressed or to ensure this no mNsnal is erchsed which might ialure employees or damage Me secretary eropeM- If
human remains am delivered in a container which is not soataMe for orientation such as demmonhal Or renta created,me
comarty will require that the remains be moved Into a suitable container before"accepts the accused. The owning of a
inerBrine"mayor or removal of emains will be adal dbefore a wdnee ,and all he Davie in privacy, send dignify and reaper.
IDENTIFICATION OF DECEASED
Name of Deceased: MaMarat Frances-Brand Nelson Miami Sti Dlvorhad
Lan Known aareea: 752 Diamond Point Road, Dia ni Point, NY 12824
Place Death: . 170 Warren St. Glenn falls, NY 12MI
Sea: ❑M INF Age: 84 DOB. 07/3111936 Dale of Death 09/0812020 Esbmated weight 150
Description a wbmadvntunrer in when remaltp sell he derval
New England Casket-Deluxe Container
PERSON X CONTROL OF O SPOSITIOX
(pamonis) In confmlol DlsresMan, glhg(QNE do Me harmartl
maybe are the evaluated agent of Oe bicameral Designated in a all or wnMn assessment evecuted p anon to Public
Imftn Lee semwn 4201.
oR
IIWa have no knowledge Mat the deceeud advanced a wnMn instrument pmwanl b Public Wilth Law Section 4201 or
wagon mang directions forme becomes of seas or Mr remains and l/ws are the Miam )having prioury under Public HwM Lew
Secti 420land havevie rght to warmse cremation dribs remains of Me dasmand. *10urmiat shipm Medeemu Ism
WI
Margaret Frances�Brand Nelson
rw..ao...rwa
WS-1ag0-f(Rev. 04120) Page 1 of
Authorization for Cremation and Disposition
bound Mom Me;rat Celow)
Number 3 Description,
L APerson rb•ianaleam where purwantto Folic tbal0 Law 5e[tlon 42011311
2. TM wrvMne spouse:
20. The surviving dd slid partner
3. Any survr ing chlltl eighteen Who of see or oaer.
a. A surviving parent
5. Amorivmg sibling eighteen Poor of age or older:
6. A mafully appointed Monday
T. Arcyreforms)eighteen yeero of age or older graded to share in the estate and who iLare closest In additional to Me Meaning
a. A duly appointed Mucary of the broader
9. Adead Mend or wave arm has exedual a wrthen inherent pursuant b Public Heald Law SetlbM201T,
10, A cheer natal cancer of a worry or a public atlmmormor appointed pursuant to the Sunnite Court Pro¢dum Ad'.
10. My MMr person who is dome on barren of the deceased and who has exeCNed a wnnen atabm Mpure are d Public Heald
Law Sent 4201M.
(UlgigrsLL REENmy MWarnpl
l—X4 Aye hereby efimr Mat the body of the decimal door not contain a battery, Wftry mat Power cell. ra posoe lmpland
or radio ve devix aM that any adds matenals were merest Mein b de execution of this ANFwiaWOn Tomr. FallurebnmOve
mesa its p for d cremation may result in Mrm W de cnmaWry and commonly personnel.
Awe affirm rhafmitmMions Mw men given to David HHAl1xander
regardi Ue removal of airy personal total or other hung of value which any person signing broad or any(�mery rmnmr of de
deemed wishes to preserve. Pine drew Cremate
a notresoundelafor the removal of personal items from Me dooderer orkan the rem&m name dedRmsed. PammalMmsls in Ne
COpalner with hm remains will m destroyed"achromosome panne and depend W retrieved aMrcr Lion.
sv�l{/ Uve hereby audonze Pine V C matory
me Vote to cremmN Ue mnsins of the deuuM.
Initial OPTIONAL)
Idea hereby author"the named Wneral dMcbr M provide for dsnvery to and cmmatlon by an BM1emtle
mstory,If deemed mcausry in Me opinion of the funeral director, and to amaM this torn to pinatas IM mind name and
address of Such alterri CMM8mry,
MML DISPOSITION
Tm Person udldmoverm the cremated remains of To deceased from Memo tOb k:
Name:Alexander-Baker Funeral Home, David H. AlexanCer
Andrea: 3809 Main Street, Warrensburg, NY 128M Phone: (518) 623-2085
The diamond Nomura of dewaset will be disposed of as blli
Return to family
n tar am reawn may person named above does not take aaueudn move=""rrrmai s
Pine View Chamatory nsud Zed to give ppua•wn of
n
the examine do Alexapdertk- er Funeral Home by delwam
in person of W oairmed meet. w«.�w x.A Margaret Frenceo-Brand Nelson
Wtul Me-f real O4120) Page 2 m3
Authorization for Cremation and Disposition
robotf among)
have understand ant it Pe remains an Mt clamew wMm 120 Can of commerce
Pine View Crematory may aisnnse of the remains in
animadveWe mever, such as by scateuff ...wo..«mr
CRE"MN COMLMFNaRN
Off(ONE of aaawngg Alexander-Baker Funeral
Pn um W be used M a container ra the committed remains has Mean purchased from u
and is described as follows:
More understand that it Me um is key that W MN May entire cnmabd remains an edditimal nym comemer may by used for delivery.
a aha ya wrtnwd, Me undweremha Met nnd am is purchased ermrored.a provided
Pine Yrew CrematW wit piece the aemataa remains in
mwauw...n
a rapid temporary container for detvery.
This Aathaozegon roan was retitled M David H. Alexander was executed at
Alexander-Baker Funeral Home
Mod) Main Sired. Warmansifteri NV 12885
and is signed by die funeral director as witmasw as execution
IM'e haw race'wM a completed copy of Ne AuMHzffi Fomr.
Ta pereoubst Identified GNow Were the "maxims)in sambi W overfamiliar,who by are of nt they Aut forever;Form, eexttst
tot accunryaMc pM nessot MeiMomaaonconWinedln OIs Autl tion FomaMaut mormhdrJhoorp a
Signed this Bth day of September , 20 20
Larry Bruce Nelson
1No Towamencin Ave,Apt. G208, Lansdale, PA 19d4mmor
Arsenio
WITNESS:
David H. Alexander
�wm.ermmaaww
0034
Margaret Frances-Wand Nelson
MS-169 -f(Rev_04120) Page 3INJ