St Laurent, Carol P1ae View Cemetery $ Crematorium
Quaker Road
Queensburyr NY 12804
(518) 745-4477 or (510) 745-4476
FUNERAL HOME:
RETURN TIME:
OATS 6 TIME REMAINS ARRIVED AT CREMATORY:
NAME OF FUNERAL DIRECTOR O OR REG0.I�STE1REp RESIDENT pEL1VEgINO REMAINS.
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NAME
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TYPE OF CONTAINER:
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PLACE OF DEATH
ESTIMATED WEIGHT OF REMAINS R CONTAINERS I
PLACEDINHOLD: -
___ dve(J�
PLACED IN REFRIGERATION:
DATE OF CREMATION G ��
TIMESTARTED: %l6 _-TIME COMPLETED.
2 '
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PLACED IN RETORT
MOV
RETORT II IN WHICH REMAINS WERE CREMATED: _-. _ L1
CJ l
DETAILED REASON FOR DELAY IF REMAINS WERE CREMgTEO p gTHA
FROM TIME OF ACCEPTED DELIVERY'
N 48 HOURS
NOTE: CREMATIONTHE
D SHALL o[ IRTARED IN rnE PERMANENT FILE OF THE cxemnranr.
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Authorization for Crematlon and Disposition
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CREMTON IS AN IRRIEVERSIBLE AND FINAL PRMEW.
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DECIALSIND
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Authoriration for Cremation and Disposition
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CREMATION WWAJNEFUURN
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Signed tale by
et(r� Xk�l'1�PRf90SY
/2 IRA
ummO
WRITNESS:
Rle.an0 Nn.�
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Carol A uumft
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