Loading...
Roods, Lola Pine View Cemeter Y 8, Crematorium Quaker Road Queerlsbury, NY 12804 (518) 745-4477 or 018) 745-4476 FUNERAL HOME: _ y .-IIB kiANI4t- _.. .. RETURN TIME: DATE & TIME REMAINS ARRIVED AT CREMATORY; NAME OF FUNERAL DIRECTOR OR REcgISTEREp RESIDENT DELIVERING REMAINS : .-.--_. _-.._�'L�E -..ea_kwQ ._ . NAME. �O( E1 R�^C. _ _�- CASE X 146T TYPE OF CONTAINER: F/ wq isl(61 (e { 7to" SkA- DR � PLACE of DQArN: ESTIMATED WEIGHT OF REMAINS & CONTAINERS _ _ __-.—W�pL--_.._, PLACED IN HOLD: - PLACED IN REFRIGERATION; DATE OFOP CREMATIONc I --'--- TIME STARTED; do 1: /Yh f TIMEL M TEO y:)o PLACED IN RETORT _JIfF�M MOVED RETORT /I '" WHICH REMAINS WERE LRFMgTED: __ OETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN qD HOURS FROM TIME OF ACCEPTED DELIVERY: NOTE. THEAc EMAT:O —.. _. - .. . --. SµntE pE RETAINOD IN THE PERMANENT E OF THE EugTOgV, _J 517T K Division of p^^�°9°F�^ ";E; s*APEOF o co,r"ce Pl orPanrv""�- Cemeteries irbra c,„.�; mencho.onadR,.a22a Authorization for Cremation and Disposition TNaANMrbatloll Fplm oust ne cwnweleE and spnaa pine m Maturity m,mmama f"Cc elm. oav:mmsaam Number- loos Crummy Name. Pm Vac Gwre4y 21 Quaker Fall CMmsd.m.NV 13e04 MOM: 5167454FAI1/ CREMAMN Ia RN IWiEVEMOU PNO FINRL PRMM. Gam coy N wind M by pec^]G'e ren"aF:m M depaused mativ mmeYU MWIq Na mmrio Mb a aenatem puMeraspect Nry we wOp}M terms Mtl am male. me and anus lien win lndlneN UW cmaune Measuring eaeepl Gone and metal, which art altl wNl Gus has BMrnmutlon. FdbWnp vwnati ,Ge ayments of M1ke reeeonable eRwb b rmmvea11 Mlle remane and oam froelal Man Ne mm " TUMw, gene maim&dual,rurebMwallkay Ee wRCenidO TM oemeL4 mil yarelecision ran... wit be mechanically tlw remane end MleiMdenlalam coapnlmlalaxH In d'opasM alnlgdlred Gy law. Thegma ll ramamawill Ge mechanically puhehM Libam"I pieces arq skeletal eNa m'lleareraum. CIUMbMlwMlm pwreally are pulveNrad uMll no angN mnmem w reaopnawu M NMwaI m.N. OPENING OF THE CONTAINER nw cmnmory may oNy open Me concern,maned and an<lemaled Mmen mreba in hinyed circumstances, such Me in repo the, ,Mossy of Me deceased or To ensure Mal no malena is accused v.M1mmuncIn emway ,or parade Rn oamme Woem. N sma ne arc Melverid Inairier by Is not sample mr Mrem xn on such as eerc mlal ore mska,me tory was rewire Nx the remains M move mte, werma a cession Mare It accepts the eemalns. The cpemnp M. mnciMr or Me mmm or moral M remans win McmM and WI amPMry nee wit be doe in Fnecs,"our Manny am m urat OENnF CAnoN OF OECIlaii ere Of ownssee'. ten Roods rn.nm yNNw wlnmwa taut K,eminAddress:4573 NYt11,Arryie NY 12801(W Wilplm Gobi F M., waelagkar Owner funs, DN © r ase99 ooe: 06/21/1921 OWaOM0.,118'NYA2o EaHuaM wMgx 120 FloreMnoe Casket bwemlmnMwnNioa cask . Florence Casket Co.Cn. minimum cremation casket (plywood corrugated raNboaN) PERSON NCONTNOLOFOI8fOSIMN (Fbmn(a)b maned mawsam.m_mar GVE are hwlyLml VNwear.nw Maplettdpent one a%uam MCNpnated Nawnwunlm elmumnle�wutM gsalambPutlo H-0e/l�.jm�l.w a�.auon azo1. r� t bee ham up,kmwedge Met th 4trmM e,ewkd a wmewmemer percent a P,,,C Health lee Semi 4201 as WK callsy0lg MkeCnns bur Me maivihn of Ns or hw rmre a ad has are the person s)Mnrre Ppodn under Public HWMlew saoticna]0lem nee Me hem toaanlmae aemaMn MMe rename of Me aeceaeae. WtOurmeNonshlptoue Meceasetsas Lola Roods COS18861IRm.M/dt) Page 1 M] Authorintion for Cremation and DispmWon laledaam ale edxbq .. Number3 Nsr M,, dYl lrWlyalagareatldw 1. Te,Wm' drown mwlNnq puwanlb Pgl[MJF Ilw'BeQm.3B1191: 2 1M woimq cones: L. The wrvwb0 contest, 9. Mury"in Parent egMeen Oar"apersgEv; a. AWry,,w wmmi S. A wrvmna eblimd eniy Oar,of Pan acMep 6. ly app g,Mmy T. Myp, )witte written, Own, W or rated os bve In NeeSaleagwM ware Orion ngK ma draft demented; N. Atl uly arrywrbd fidlryal PARIP, I. A.ow tCMwre nOcostway onMewMen¢blmralWrtuan PontaXeaM ew hanIID11]I: 10. shelfofficer of f costly m a PMWequnba ParsJantUwayb'e Coon Prow 1� Myotherporsforwho bxtipmCeIWIOthe downward and Mw Ma exeNNa"bay¢IaNmeT paramount by soc NaeM1ll ts.,seManamllll r au ma ad faibwmm .: Wine we eMm ban the body q an axdsM Mee M colon a Mary.widely parr.pow.Pay,redoesWa Winslent, w redbacavedevlce ana tlutanYa dr muutiale weeeremoveapvmule exeww,wmis aglWeanon Fo.m. Fauuxatoremove, Mary Ilelns plJ[10 VMINm may sew/1In Im¢mb NeuWIIaIM'mlC asasllelo¢Y Pelsannq. V • /VWealfim alallmNc[vie love Men pivenb NYM NIYrur av Iegeldiy Ile exmvalWanYPolwnalf apetY osdlleradlV d��lulNN wFelsdlepep bN' uenY lenity msmMr ollM1e decreased vael'a+to peserve. own Pm Yww Gdnetlry is lwlnepcneNah ate.emwaldpersmal Ilene M1o'n NewnM1inelwhanlM.emainso(IM1e dewaeed. Personal Items left In the mda_ IMf vwith remains will 0 destroyed by Na monandry proars and cannot M rdnevet year cremation. - (J/^'�/�/Nye Maybe,alkhodn pry,VO,Ctemabry 0 water tle tlnalns or Ne damned. IndulOPTIONRIJ Me hereby auNwae Ne Wan N Nmnl cMd0r to lNVMe M dM'M'W eM anywa y'by an alternate abn.11dxmedne 5sv mtl oplmmnof Ne Nns Alec ,,aMbamend Nb Imompmide Nemmc<nameand whereas of with alNmtle¢remnwy. FINaL pBPO81TION 7;7v uO b lemlve the awrelM Paul dam how]Ynntls awngM W. Wme: M B. Mimes Formal Hare ass, In Man a satire,NY 1IDl10 518d966R16 T TIw oarward remain d acxee]M be dquaN g B low rcn.m lmeanar.wlamlrrr.e.mashes.�wpaw®arqu.owl.mdl.l.lrn. ' Pwv clnlmry b.uNa®db pnlp®oald NeIw1Wnsb MB.N FWWIYnl�s� pdtlh'oY Frrrraaw In peso o Ey IejpaM mq. lb Rye ' yesora OPSI80f(Nev.012p1 Ppe,3dJ Authodution for Cremation and Disposition V" IMb uMa'aWtl NelRtlwlsi®oere MOtiM vdOM IMM'AdaunEm. Rne View Clemi nvYylyye plpylglMMF an Morev.eb mein rM se M vsse lq. nwrrwed CKFMI CONLNKEFi 1 are o1m9e1 rml M um to[e ueetl n a vnulrwrMTeaememil renulmlmben pudlveet M1un MB.I(Mur Fuwl lbnn and m dissected as Wass,LW &"mom me umme FM if this wn A mo. to hi Me ensue ven.l.aiem.:u.itmmrItldimwF.raw Mei..a frd+leeelY. DR M um w M plpeW W. NYeutlsLLMtlmltlrounwputllOtlaaFexw FmAdn1 MpW rleosmW IameFe In lrwu�m a raped IempmeryanNnerbdNwY This AulMnialFn Form was gmpMb/ Kri 'aae ewdtl e1 fur" MB Kilmer Funeral Home 123 Men 31.ArMle NY 128M P�urel and u will Muo freer dweclw ass Me1i AS IS eveobn��w i new m is comphi spy of tltis AuNoneatlon Fann. me plseeni MCMlled Mloe wan the persMds)In mNol or&MISSilllon.who M slpmlp MIS AUNmiaanon Flesh,aMsilsl M Me Mee"MmlMlelmwea M Me lnMlmachecondensed In MIS AuYW4elMn Form Ndaitharr 51 MeloeSpi Blpmd this Gry a!litin m .28� amleddM i eRne�m u.sdlMm.Fr,IN uem Miami Ali NTXFBe: P KNa I®mr Meu.vpe.�s+w tAN) IA bN 008-IBroi1Kw.012p Fgy9o19