Leombruno, Joseph Pine View Cemetery
crematorium
' Quaker Road
Queensburyl NV 12804
(518) 745-4477 or (518) 745-4476
rUNERpL NOME: - M6 /��1/Ey(�[
- '-"-"'- '--'- - -_. RETURN TIME
DATE 8 TIME REMAINS ARRIVED AT CREMATORY:
NAME OF FUNERAL DIRECTOR OR RECRISTERED RESIDENT DELIVERING RE(
MAHCH
----- --
NAME: ��� �ca10RYt1a
.- - CASE N _.--fly
TYPE OF CONT4INER N: 1? W�
PLACE OF DEATH: _,—I•YI( $�(P �I-- � O
PSTIMgTED WEIGHT OF REMAINS 8 CONTAINER__
PLACED IN HOLD: r�
PLACED IN REFRIGERATION: __
DATE OF CREMATION: ,-�'p_EpAp
TIME STARTED: JJ)F= -. _— —TIME COMPLETED:
RETORT! - ctI
PLACED IN -A-1—
CREMOVED: OJ/ZFL
RETORTpIN W CRFMAT
HICH REMAINS WERE gTEO: � �g—
DETAILED .•.r
REASON FOR OFLELI IF REMAINS WERE CREMATED MORE THAN q8 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREM
ATION LOG SHALL BE nETgINEO IN THE PERMANENT FM1E Or THE CREMATOR
Department oak
two
NEWYORK i)IVISIOR Of DIVISION OFC MN MES
ETA E°F
° CemeteriesMissouri Av,n,e
Twap 1%ems 26
ww«.dw.nraw
Authorization for Cremation and Disposition
mis Autlw ass Form mwt ba OMPI tl and signed poor to delivery a morn ra for canal
Dom,,August 19.2020 NumMr. IV
Crem&ory Name: pine VNw cmm
Addrems 21 Quaker Road Ou re redury, New Vak 128U PFme: 818-7a54A77
CREMATN)N IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremation Is carmad aN by pull Me remains of too de¢ased and Me conlamer holding the moral iYa a counsel NNnberWM'e
tlwyanu WWto Intensehilland Peme. The beat and flame will limitations and consume ev cry n eawp tome and amid.
%mA m am all Nrt will be NR after cremation.
Folowlp Oon,Me crematory will lake rmsorable arch to remove all of the remains and oNm owners from Me ryeme4on
chamber M were minimal duel and residue MII likely be left behind, The cnmebry,all separae ihdmnMl and formal matenal hen
the remains and Meiocia l and foreign malenal wdl be dispcsM Now required by law. TM aemaled remains all be meMenicelly
planned into small paces and pawtl into a designated xnWlner or an Committed remalne generally an wi"M duntil no
alrgla Fragment A recognizable as akelehl team.
OPENING OF THE CONTAINER
The oemalory,may only open the canbiner holding Me unammaled human remains in limited Grurrtulerrcs, such as to confirm the
Werni m the accounted or ensure mat no made al as endaeed welch might injure sacraments or damage the eremmory pmpeM. N
hum armed me m Mitterrand
a cnalner whim is not emhb m le for cnatlon such asmaterialor metal uskm.Me
ora m
will r¢pmre that Me moral him ba moved ilea a oultable conYlner beMn ccep Sab Ova lase w
s. The opening m a
mmamer or the bawler or remove)mremane AV be conducted bevel awt s and will be done b arms,who highly ail reaped.
IDENTIFICATION OF DECEASED
Name of Decennia: dcaePh LecmWm Mantel Stylus. Dlwrphi
Last Known Addrew. 15 Formal S ,Apt A223 Seal GLvrt Fella, New York USED
PlemmO hStale V&ley 1 M21 Miami move 40 Sol Ny IM32
Sad: pN [IF we. 79 DDg. 01-31-1941 ale OF Death 08-18-2020 Emeateawelgm. 150
DetaipNn of makeuwmainerm which an ai s will the dowiwad
Florence Casket, plywood corrugated cardboard container.
OF ON
(Powsm(a)mmMolo(paPosidwo. anchor ONE news lW mN)
I amMle we the designated agent arms Miam tl amanal in a will moral momment executed pursuant to Public
Heats Ww SeNon 4201.
OORR-'
laws have no knowledge that tram deweeed evecul a wmen InmNmel wrswnl N Public Health Lew Section 4201 Or a
w W Pairmining direNms for the dissociation of his or her remvm and IMe ere the wrea ds)hall prom under Franc Health Law
Sonclua of and have Mengnttoauhomecremanonol Me remain¢ortlndemased *y rmmadonshlptodwdew ism
rollew
Joseph Leombruno
DOS18911-f(Rev. 011 Page t m 3
Authorization for Cremation and Disposition
(IMW nre�Wnl
IN uMrarene NatdteremainsarenaaeimmvnmmlMpaysWcmmaton
Pim Vim Cremel
nuwmnwd may tlbpose W the remains in
an iho Mevade manor,smem Me by w in0.
CREMATION COWNRENURN
Qyya ONE dNe/im")
-rl-- M um to be used in a ammonia bm the channel mmyn ,Ms been WxNaeE tom M. B. Hilmar Funded Home
and is dexdbCd as tmlbNe:Bass M0lhat NI W tlemus Om
INJa uMWa Mtr If Ne um IS om small W MM Me al OMIBKd remains,an abltmal eglo WntaiMr may be used tw del"
-OR-
M um a M yet mrccbau6 lI understaM NM Nno um Is Maddened or Minimal pwNed
Pim Vim Crematory will place the ne names in
wwdmxaod
a died temcer"mntaina lw del very
Imie AUMarsadors Form and Moment W CMye C. N pm vna eaecWd at
M. B. Kilmer Furerel Home Mwuwwwm
136 Main St. So al Glens Fell. New York 1?B O
man)
and is slOned Ey the humeral dirMor as wemsa to its esewtlon.
lime have mainland a coastal many ormis Auuomaeon Farm.
TM penonp)iaeral IMgy blare Ne"e (s) in control m1cabatl6on,who by signing this AuMwzadm Form, ad t(6)
to Me aocumsy ant cmmpIhdwmms of the inbrmnton contained In Ml AuM mh arbn Form and auMoriaste)Me lonlyang.
Signed hill 19 day MlWgust M20
Tyson Lemmwnm
1451rz Main St Sol Dome Falls New York 12BW
WITNESS:
Glue C. Korcpka � C yL
rmvroiy iffm w
01932
»aeon L®.mbmm
Irw..woe..N
DOS tawf RW 041 all W 3
Authorization for Cremation and Disposition
(Inamfi Nellalbelowf
Number; 5 Descil AnY Suffolli Bald eighteen Years of age ar older.
1. APerson designated in Will pureuanl to Pul hoafth Law Shim 4201(3);
2. The SUNNIng goose;
Pa. The Survriaq dOnmdgc parner
3. Any surNVing Miif migration years of Sea a oUer;
A. AsuMNng parenC
5. Amorning sibling eighteen years of age Or older
6. A Wealthy appoint¢!gualuman:
]. Airy person(e1 smadin seen or age Or older enAed 0 share in the ea181e and who iYve dweal In releEonamp to MCExeaeW;
S. A duly appointed 5dunary M Me wished
B. A base tend or einers and has e[6uled a wmanehrament Wrsuant to Pudic Hardy Law BetlioM201(Tl;
10. A MM wool ORwr of a ocu my Or a public administrator appointed rurswnl to the 5un(gah'e Laud Procedure Atli
102. Arry Sher cerson who is aping on MheH or to antl wM has ev¢al a ar settement painful to Public Health
Iaw Section 4201p1.
gulA 1THNEE of to farow eg)
LLcII hereby aRrm that the Mdy Crthe dec does nor contain a batter, battery pack, potter an. ra]ioeal¢¢imphm,
or radmisaw ,tlevire and that any au ti melenele Mn remded prior to Me ueaMn Mthis AUMotlzatlan Form. Failure b remove
tl rte//Maep rtocmm onmayreauKin MMMatecmmabryandsre gpar ".
IAl al than In&rvq'ms nave been giren to Claire C. Korea s
MsMirg this removal Ofa"dersmal prop¢d llm y Or a thing of value which any ces rso gniog beliefs to a,M lry mgmbar of the
deRaeetlwtNesbpreserve. Pane Vim Creme
unMnepone1k Iry MeremovalN"monalitemskOm IMmMinerashentatremain¢ dMed eased Peredral IamalMIn"
a�abe/lmr a with Mc remnewill vl be destroyed 4Now cremation pro and cenm be remained!Sifter Cremation.
1L,Wase M1aeby vuModae Pine View Crematory
iaer+ma to cremate Me rename as Me deceased.
(OPTIONAL)
IMw Mreby,auMOMn her Monte!formal director to provide for Malawi band commel ay or alternate
matory, if dxmad na "q in Me opinion&Me Mnaml dlrecbgantl To amend this(am to provide Me correct Mama vat
am Mauch aiwmah crematory.
FINAL DISPOSITION
The Persian aulndM¢tl to reNive the cam mead hmein r oL Me Toroidal from the uemelory is
Nam M. B. fill Furehl Home
Addrey; l%Main SL. SouM Glens Falls, New VOM1 t2893 PAne; 518-045-8118
The crematedr ns Mdeaas will be dlsFaed M as alcons
So" To Marys C~Sq South Giants FaMft, Now York
IT he any rum the Prawn manage games Moo net hike posse w Mlhe cremehd remain[.
Pine View CamVOry Is eNhaized to give p WOnM
NOAvm U++ei
Me ameinb M. B. pgner Funeral Home _ by Nlivery
'm pawn or ay remslwed Mae v.wttmneaeph taampdma
DOS-18584(For,04con va»u Page 2of3