Bennett, Penelope "Flue View Cemetery & Crematorium
Quaker Road
QUeensbu ryl NY 12804
(518) 745-4477 Or (518) 745-447s
FUNERAL MGM,: _ _ y
DATE a TIME F E"LFFS
ARRIVE D AT C -
- - RETURN TIME: _
NAME OF FUNERAL DIREc Oq OR ECREMgTOR y; llil
RISTEREO gF510Cvi DEL4L
huKR I VERIND SPRAINS.
_
NAME
TYPE OF CONTAINER nc -CASE D )wp
pL,l[ 4� , '
PLACE OF DEATH:
_._ Thl
ESTIMATED INVOID WEIGHT
PLACED IN OF REMAINS 8 CONTAmER_
PLACE :
PLACED IN REFRI GEµATIOeL -. ?
DATF OF CREMATION
TIME STA
RTED:
PLACED IN RETORT I I t' I ME COMPLeTmo.
RETORTN IN W 44 "'MOVED:
HICH REMAINS WERE CREMATED:DETAILED REASON FOR DELAY IF REMAINS WFgE CREMATED MORE THAN FROM TIME OF gCCEp TEO OELIVEq Y� MO
AI'I VD NOVRS
NOTE Tee CREMATION LOG SHALL Be RETAIGeo PN THe genmgx[vT Fite OF Tqe COeMATOm.
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took
NEWVORK OeWrM ere
sTATEOF I Division of DIVISION OF CEMMEMES
OPPORTUNITY. Cemeteries doµ C "w a Plaza
Ion Aroma
shins,W 22v-0mmr
Teri rallaw5226
Authorization for Cremation and Disposition w.,,aaem_gw
Th18 qugoriaatlm Farm an ON be car d and algi Poor to Wliwry OI remains her cremnon.
Dora: 9/8/20
Number /poi_
cremMory Name: Pine View Crematory
Abdul pusher RwE, puaenebury NY 1280f 518-TaSMT
Pbe:
CREMATION IS AN IRREVEniRg AND FINAL PROCESS.
Creinnat i8 mmW OW by plating Me remains Of the tlareeal and Me together Fading III¢remairo intoacr¢malicn Clamber uMre which day Weyam
all
lMat anymore m but
elreatentl flame. TFp FxfeM Nme wild lmimm*aM Consume av ing except home and Masan,
NanµareallMR wily be Ie Met after Pentagon.
Following cremation,Me uematcry will bke reasonable egortsto remove all of Me remains and other matins from Me crematdn Member, but some minimal duet and R&Eue will likely be Iefl paned. The cremaory will motet mcder and brthenm al from Me remains and the tncidenl9l and ryrpgn mMenel Will be disposed Of as ROuired by law. The Mmeted tamales will M theManic lly pltiverl2M into smell Berea and fared Ind a dominated contarinar or urn. CmmOb remains generally are puly =unillm single fragment is recognizable as ah lOaue.
g�
The crematory my Only open Me wrMiner halting the unaem human ramams to limited 0mumstanres, sun as bmnrmn the Of the moreover etl OrlOeMure that no musical isenCli whits might injure emplay¢es Ordismage the crematory propeM- H
human remains an delivered in a cOnhlmr which is Mat suitable for crem"on such as ceremonial Or Mandl Ook4 Me
meal will n uln Natthe remsns be moved into a suitable Omewner before aaccepd tm mmlm. The ovemrg of
cOnainer IX the MenAx Or Women Of remains will be Conducted before a wttnesa and all be dam in pivary, Wish Mindy and ma .
IDENTIFICATION OF DEC�ED
Name aomeaaeM Penelope Bennett
Lae Nncwn Abdul 1662 Glens Falls MOUntlan Rd., Lake Luzern, NV 12W nasal sods.
'
Plano Of Death Saratoga Hospital, Saratoga Springs, NV 12886
sm', ❑M IS 74 11/4/1946 9/62p
Age
:_ Di—Date a Death Estumred weans: 1$5k
Defendants awkeu¢ndlnx in whits remans will be dMi"I
McDonald basic cremation container, no interior
PERSON X CONT_ ROI OF DISPOSPirld
(Persm(s)m owani ONE arbor Mtal
shwa am the designated agent brand dttb designated in a We or"Mae tnaWngn aaeNled Moment to Public Hector law Section 4201.
R
-Ol& — INJe have no knuMedge thin the dewywdexeAled a"ten Instrument pursuant to Public Health Law Section 6201 or
an concerning dtreMms for the hspoLOCn Of his a her remains am Me are the cereral(a)having prearhy under Public Health Law
Sai 4201 and have Me fight to auMove Gemrsion of Me remains of the dOxased Mypur MigtO MP NO Me demased B as
rollwre.
Penelope Bennet[
DOSi fTher-0rtnv7 Page t of
AUMorization for Cremation and Disposition
(IniQ mranlnai
IANS undimmed Ma rue remame are not aaimee wimin 120 Mrs aAre radma,
wen chemaary
last inetdev.ae manmr. mumm MauMd ""'"""'°'" mryeapmmamer.rmiMM
stem
C29MI&M_ Nam`
(�ONEdIM MI wug)
An urn b be used as a mmtincv(or Ve vemaby robins Man been toodr gp learn
and is dearnbed AS Mumm
l /We understand Maul the um re too amen le bad tie wrlpe vemalM renWna an additional red Wait may 5e need mr delivery.
RJ
3{w.lL An um harm va ouetlleael. Maine uidgeand Ma If no um ie promise I, mandany woviem
Pme Vew cremalgy
A+nwpemnp Ina Plane the cremated remeins in
6 Vd hmtyrarr" ainer for del'nery,
may AUMoryastlan Form wee Pmulded Ey PalnCla Miller
Brewer Funeral Home, Into rn..wa�w,.y was executed at
b Church St. I ke Waeme, NY 12W r'•++x+nx mi
and S etgreofov Me Mistral Sasser as wtphem b itsmadman
rum awv
IMh have removed a rvmaeted wpy Of MIS Autlwrimaon Farm.
TM Restarts) identified Mlaw bean Me Rersa ls)in cmbol a Mspasltlon,wno br signing MIS AuMONatlon Form,aXyys)
So Me accrosm? land cpngaares of fire Infwmsaon wambwe In May Aa/ewlalNon Form and auMo s)the forgoing.
Signed MIS B Mr Or September m 20
Belinda Benner
0.: D
19a2 GIeM Fella kmuntain goad. Lake Luzeme, NY 12ege �
WITNESS:
Paetaa MNer
1bl&5 nrrb ryy �nS`rnra �ii11,
Penelope Banned
OOS,R�f(Rev. OW15)
Pepe3a3
Authorization for Cremation and Disposition
(rnmt Sam the ust shMa)
Nunar 3 Haiti child
1. Thismn�gignakd in wiring Omauamm pi HnM law Modes Nl(3):
IS T simmiig eme
a srk partner
3.A gYnumnng cells eimban Years Of ads w oVXr',
S. A urviNnsg mrem
5 ,
S S. AmwPou g meting eighteen rears of age or Phil
r apaommd guardian.
L Any permn(s)eighteen years W age or Older entitled W M chi of the estateare m Me estate am wa!Were down Rierknanp m me aemevee;
B. A close aheadm rearve who as sex ¢I I wMan aRmmr
10. A Mid firal Officer Wa2unlyda cubicadmlme Mr WrsueM to Public Health Law Seglm 4201 in
IIS. Any Other Mr nWho l¢acting m behalf Of the dara5¢edannd who has ancedgd ated purt to the SwlttenaderemeM PrmMure Aq,
Law Secpcn Sllight(N. Pumuamm Public Heats
bided ALL THREE a Me moreseed
INaa nerebraNmn Md Me adr cr Ma eema¢ee goad bW mnmin a anarv, anery pad. powermu, meioamae imgam.
M2dlovAve drvice and Mar anyauch mdedals vine Rmovel prior to the evemrim Out AUMOrhatlan Farm. Falfun to mlove
thesss Mare cnmaEOn may mull in harm m Me cmnatwy and cmmaWry peraan nel.
IT N ) IMb aMrm thd lnctai We have bxn Pemoe ii
Mean to
RgeNlre be removal Of am Me al pocety or Wier thing W value which any on aiming bNw Or any family merrier am.
eemaeed wales to preserve, pine Mew Chambers
is nN re¢ppnybk fOr rM1e Rmmel W persbrral dame Fain tM mnteiMr prhpnla Rrrmne ofMe Waaced. p mOnaleaaratekln Ne
Cbntelnerarwh the remains well be M Myed by Me Ommdlan Pm "$and Cannata rXMVae afmrcm Man.
&A Pine Mew Crematory
113i1,) lIV/e M1anby autlgrim
m
m mmHg the Rma Its M Ma tlB[eeesd,
FLNAL DISPOSITION
Tape authorized to reccve Me cm"W rarnins&Me acm¢ed am Me gem Is:
Name: Srwro Fumed Home, Inc.
2i Atldmu'. CM1ui M, Lake Lux . NY 12M 5154By1TM
PM1om:
The namdee remains W dexaud MISS a deposited
W MeNIM
b Li n I I n L I I>Ui 1 tl'Iryp-��
Sw.LS cn he inn named abxra aces nN take�u mof Me uemded Ringing
the neremsm
Brewer Furwml Mare, Inr rs authplxed m gve pouaylpn W
IA.Mere..w,++t by tlelvery
in pMon a by IeDdered mail.
Penelope Beonea
DO&19W-1(Rev.Oflr15) Page 2 of