Conlon, Sheila Mary Pine VIeW Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (516) 745-4476
FUNERALHOME: _,_ f. -rU#tt -
ID AT CREMATORY
- T -_..._._ RETURN TIME:
PATE 8 TIME REMAINS ARRIVED AT CREMgTORy:
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDEN{�D�DELIVERING REMAINS
NAME
_�..CASE N
TYPE OF CONTAINER _ Flom*
vY�f 6 _n,Lla� n` Nl..
PLACE OF DEATH:
ESTIMATED WEIGHT OF REMAINS & CONTAINER /I` -
PLACED IN HOLD: - -/60 It,.- -_fm; -
PLACED IN REFRIGERATION:
_
DATEOFCREAI Gi J �-- -
TIME STARTED: A� T1 -l-L -
" ��1_. mE COMPLETED:
__ 9'I
PLACED IN RETORT .�JFI'o ` --
�II MOVED itj� I q RETORT IN WHICH REMAINS WERE CREMATED: _ _ � �F1�
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED�RE TH OORS
FROM TIME OF ACCEPTED DELIVERY,
NOTE:
THE CREMATION O SHALL RF RE
TAINED IN THE PERMANENT FILE OF THE CREMATORY
—r"E " roRK Division of ° ° "`"'"a`""STATEDr DIVISION OF CEMETERIES
oPPO0.1VNl]Y Cemeteriesne Commerm Plaza
fly shNgbn Avenue
Albany vhWl
ielep ere.I51H1( N%
savivikii
Authorization for Cremation and Disposition
Thus AUM ad" Farm must be comp and will POwW Eellvsry of Mains for cmna .
new ReGemberA.2)20 Number'._ DID
Cr ory Name: Plan View Crematory
Address:21 Ouaker Road pueensbury, New York 1280a
prone: 318-745N77
CREMATION IS M IRREVERSIBLE AND FINAL PROCESS.
Cremlis earned oN by Placing the remains W Me deceased and Pe wmainer holding the remains into a GOmat'Iwl Chamber M
May an sAWe W intense MM and Mom. TM1e 1 t Me Same wRl legitimate and mnslme sasryNin0 secapt bone and may,
which am all Met W 11 y left aXer cremation.
FGlamng demnlw, the cremaory An take maaonadle egonsto remora all of Me remains and other material wm the cremmgn
Chamber, but arena minimal dust and rescue will likely be Ian Wind. The crematory will separate mddemal and foreign material them
the remains and the modenw end foreign matenat fall be disposed Gas required bylaw. Tire aemlaee remanawio Ire rrwmedwlry
unissued Into Small pings and aboard into a designated asmairLY or Um. CMa%d remains Wmmily are puMrlvd aril no
Small fragment is recog nbableMy sMiWl Marla.
OPENING OF THE CONTAINER
The oem"may onry some the container huddmg Me unuemated human rem wm ams In limited drstances, sum as to wrdrm Me
Idemilr olthed tesea orto ensure that no mmmial is enclowl which might injure 0mpbrees or damage Me conmato"Operly N
human manni am delivered In a conyrwr which Is not suitable for memagon mach as Ceremonial or renm Caekst.the
cMOWW lmre that Me Nu ber ad moved into a sudahle container bemM m It accepts the remains. Theapeng Ga
All m
omamer or the transfer or removal of MMIOS All be ocnduoee blame a manes and wall M done in physcs wain dignify and reaped.
Name of Dxaeaed. Sheila Mary Cmlm Marral Sbtus: OwO
Last Kmmmr Addrw: A Hemp F Sbeel Queens marry, NY Ithil
Rom OF Death, Glen Falls Howe ll tW Pam St Glens FBN. all Ypk 12MI
sex'. OM t9F Age:73 nos. 11/22/1946 Date GDeath O9G4-2D2o EstimatedWelgM' 150
Descrlptmn of CaskerICNAMW 10 whit M.Im An be dalvered.
Florence Casket, plywood Control Cardboard container.
PE
(Pemm(af MCar l W dsrsom M, in@eI ONE Of Me{dmwrpf
I smile are the dwd9wwd agent of to dace designated in a toll or wntheninstnme1 exerted proved W Public
Hearn Inew Eaolon 4201.
OR ^
�� W IMe have not knpMedge Mel the deceased executed wripep insVument pursuant le PUNIC HealM law Section 4201 or
all amsalnmp duegions Car the dsauaTn of his or her remains antl INrc are the perm s) having pnomy under Public HeaIM Lew
S on Q01 and have the nitrate Outhorim cremation GtM remainsdMe de d *10ur Madonshlptot dsc isas
fallowe'.
Sheila Mary Conlon
DOs18WgRev. Dana Page 1 of 3
Authorization for Cremation and Disposition
ltrderc from lne rrubWaw)
Numl5 Description: A deal sii erehtcen years of age or Pays,
1. A penan designated mwrifng Pursuant m PoNk Hmun Lax SMion 4201 ON
3. The Burl mature;
L. The survrving dames(parineu
0. Any surwhanq oliW eyMeen Years of sage Or BMer'.
<. Asurning parent,
M A surnWng sl0lirp mightean year; Mope or oltlen
& A pwbYlY addresser quaNian:
7. Any pCrarns)ngdleen Years of age Or older MtAled to share In the estate and wM'Were Clayman In reladWM is la the deceased:
I. A duty appmMed fMUGiary of Me eslane;
p. Adose MBntl or relative"afalls eieWled a wilXen slalemmt Wriduant to Pudic Has tin Law Sewan 4201f�;
10. A chain fiscal oMmr of a Cal Or a as Wic administrator appointed pursuant to M¢Suncyate s CWM1 Procedure Act:
100. AMdher persm who isffiing on behatl of the deceased and who has exemkd a wnMn slatamenn WreuYrtlo Pubsc Health
new SWOM,0201M
Moral ALL THREE M the faffiwMy
IANe hereby affirm Inat Me M]y Mthe deceasetl M89 nM wMain a baryeiy, patl¢ry pxk, power C¢II, r ddeade a implant,
OrredimcpW tle:re and Mail any euen maM swemr mW fel Me mz n NIMSAUMw"Um Foml. Failureµre ore
Muse hams prlorfo cremation may fault in MmI Wµveramaµry and cm MN pereennel.
Afte WI thatlnstrudions have been glvM To KYW Warier
regarding the emaval of aM Parsorel Property Or order Ming Mwill ranch am persm still below or any family memW aMe
dereasedwiµestopMem Piney Crena
is nor re0poneide he Me removal M personal moves from Me Formner'Otrot tip remama MMe deceased. Pemmal lame IM In µ0
Cremation tin or wiµ tlp remains rill W deeboyed by µe crema0m process and cannW M rabieved after cronex n.
hereby auµonm Pine vim Cr¢manwy
W cmmam" remains of Me W[emed.
(IMdN OPTIONAL)
them MmbY Ar horim Me named funeral director ro provide far delivery W and cremi by an aNmat r
vmM IT dealamecom ytothe opl nl on 0f µ0 remremains,naral riO and tO amend M M N le form W provide O COnA Memo and
diddleas of FINAL DISPo TION
Thep nauµci WrwNe the Cremaed Wmains M Me dwdmdd from The aemaWryis'.
Name: M. B. kroner Funeral Home
sell I IS Mein SO Smth Glans Fells, New York 1] Pam¢, 518-0A58116
The Chiral remains of dere6aM will be disposed of as falaxe:
faunal St Reynmda Cmwdl amm,NY
If or my resin Me n named above does M take remove lot Of Me cremNM renuiM.
Pine Nix CrenWory w� is auMmzed W ptre pmaesaona
Me remand to M. S. Kamer Fumml Homen r p,dMrsery
in persm Or on defitleant mail. Shear Mary Gorton
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DOS 1803f flier. 0G2o) Pay203
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