Young, Louis Roland Joseph Pine View Cemetery g Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 Or (5I8) 745-4476
FUNERAL HOME: . . - _f(,nu40D -nl1SE� _,--.__ RETURN TIME. _
DATE S TIME REM "-AINS ARRIVED AT CREMATORY:
UstpNAME OF FUNERAL DIRECTOR OR REGRISTER[D RESIDENT DELIVERING
ING REMAIN� :
NAME: �—
OJ YWM(r IDOZ
TYPE OF CONT4INER . II— �LSt —CASEft
PLACE OF DEATH:
ESTIMATED WEIGHT OF REMAINS S CONTAINER
PLACED IN HOLD;
PEALED IN REFRIGERATION;
DATE OF CREMATION
TIME STARTED:
._ TIME COMPLETED.
_ a";3 f1
PLACED IN RETORT _ //.. (�� )}j 1'R'V-"n
WERE
CREMATED:
...__MOVED _IL NJFLL�_{��OLI7
RETORT 4IN WHICH RfMAIN$ WERE ORV-EMATEO; _
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED P
MORE THAN qB HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTEi THE CREMATIONFOG SHAILL _ ._ . __A .
Stare
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Author[Wion for Cremation and Disposition
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FINAL OKbaT N
M T Person Nna¢ee to at the crcmea0 reme sNthe aecN hOm IN,uemaiory is
N ELMWOOD,MEUNIE
AEEress 97 ELMW000 AVENUE SRO) -P6f Sb g;2
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