Weblow, Janet Marion Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: J-
_. -_.-...-.. .-.._.._.._. RETURN TIME
DATE B TIME REMAINS ARRIVED AT CREMATORY:NAME OF FUNERA _ -
L DIRECTOR OR REGRISTEREO RESIDENT DELIVERING REMAINS:
NAME. .._-=LK"+P _- _NERLa✓1 I ppff��CASE IT
TYPE OF CONTAINER:
PLACE OF DEATH; — p5(4 -
-- NCI"1- ------- .
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER 76L
PLACED IN HOLD: z;� ---'-
PLACED IN REFRIGERATION: __ --
___
DATE OF CREMATION:
TIME STpgTED: , COMPLETED: --
PLACED IN RETORT: - _MOVED: 4
,
RETORT p IN WHICH REMAINS WERE CREMATED: fiq')'r �—
e. 4 T
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE TH--Y—qN yB gpUftS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL DE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
���III
— J NEWYORN Division of YOFM�i
JZ— Y5 At OneITTE'
dom
°°" " Cemeteries Or;^Awn-
135000r
TNspMne:RGIaRaTl6
Authorization for Cremation and Disposition
m4 rlulhMwftn Farm must bs Completely ant Signed poor Ni delivery al Minimal For cnma ..
q
pym. OftNun6ar: 4
cmmmryN :Pim View Crematmhum
Pddrem:51 Quaker Road Queensbury NY 12804 Pnpne: (518) 745- 77
CRF nON M M IRREVERSIBLE AND FINAL PROCESS.
Cnmelwn is camecl cud by Pinang She demands of the deweaed And tlmwrMiner model thm mnwlm Inb a oemabn chamberwlwa
tl are internal to nawl MN and Nme. TM M1wt arts/Bra well Indnaab and camum emerging exmpd bone ant n 1.
"fell am a1I not will ba last Nbr cnmatlon.
Folcvnng cremation, the commonly well mks remonableeflops to remove all of the nomene and other n deal from Me cdemeOM
Temtel bud some minimal dust and rmidue will IiMly M left beM1ind TMP ma mllwwcaNinddenmleMkmgnmadwealham
Me remains and the MaMml and small m@lal sell M diagased elm mWred by new. The aremNM remains will be mnMniewiy
µMdttd idea small p'osel and pleased into a designated wnWmr or um Cm remains Malawi am pulrarhed uMI re,
NryN Ngment M ncognlsable As skel Nam
OPENING OF THE COWMNER
The oemabry may only open the container holding tee unoernated human remains In limited uumslanres,suU as so confirm the
kenily dtee damased card ensure that M material is another which might injure employees or damage the oem fiery prgRny. N
human ramtlm amdsllwmIn aaamlmrwhl[M1 is notouMblerorcnma suchaswMonealorn lmkKMs
nmrtary will nual that One nmaem by mved Into a suitable somewhat plora N accRSM Me remahm. mine Kenirg of a
mnminn or Me transfer or removal of remains will W conceded doom a wow"and wall W dons,in Metal with fig?ry BM resgct
OENTIF"nON OF DECEASED
Nam of Dommeal Janet Maron Warbbw baHeda s: Widowed
Law xdmm Fdaega70 Sheridan St., Glens Falls, NY 12801
pace df psag,:Glens Fells Hospital, 100 Palk Street, Glens Falls, NY 12801
Selo. DN OF Also 88 DOG: 1X1111931 Dmdp 08 l MO20 EsxmeWal g ao -
3AM of
Cesogtiyyfn4NwMelMrin wR be delisarad.
L-�C d.�l_ � OpFLg1=
p new lxp nnrw IN COS
Mwr mom)in ernlmddappwpn, lys'(Ig oNEafMMbwNq)
I amble uem Designated egerd of Me 6 asemd dmgnamt 0 a sear uw imumeMemoatM puawntm PUNK
HNM taw Section 4201.
�AyY�
!�J]L Lyle he riLnoxlelge calm�MdHd whisco ]a vmMnlmoment pursmMic Public Heats Law Setl'M 430l ore
conwmini�g dlreai sMtneaispwldon of his or her lemmas and lore are Me post tivvg pdonly under PUM[HmhLaw
n 4zot Pat Me rgmMadindrtae oemadlanMmemainedMedreaaed. Myrour rel.tlomhgromdacem.eMs
Janet Marion Werti
DOS 189"(Rev. Ol pegelda
Authorization for Cremation and Disposition
nna)Mnne oslarow)
Number 3 ofarsedgion:Child, Leune Bellinger
1. A perwn Oeaipnated in wriing punuanro Puck HaNM law 8etion 4201(3):
2. The whrrving spouse:
Im. The surviving domeatk putter,
3. Nry cwvwmp Mid eighteen years of age or after.
a A denying amend
'.
F. A human mlxlrrg eighteen yeah W ape or Often
s. AlfaM1rlM eppciMea gmrtun.
i. ""mainly)aglrnen man of no or Wrier a~W tail in they,661eh and who lLem Jxml In nuadmnship b Me dam i
a. A duty apfa irted fidi W Me babe,
e. A dose Mend an marine who has executed a Mftnslalgrcnl pursuard to Pudic XealN law Syl4201(i):
le. A Aimed Andal oXk¢r W awume or a public adminM gylMM pul l to to 5umgere'a Chat Procedure Aci
tea. Arry dMr sell who is acting an Fatag of do Mainland and who Na exewnd a written rotemem pureuenl w Wdm heath
D4zmatWtlrehammeng)nby almm mad Me body the awyeased many nod minor aEeNrY baNn male power rail.retlioaaN Intent.
and that arty much meterim were removed prior to IN exacuum W this Autlwrlutlon Ford, Failure W Names
"h items cramagon may muh In NrmWMe cremedwy and cremetay panonrel.
/AL�j�artamrm Met inedrudimahave Been given to ten
dvah.Mulich
Me removal of any personal pyeM or after dhirrg W vale which any Peron signing bekw or myAndy metal ce Me
terasaedwimeampnsene. Pine View Crematorium
efarda removal W pereanal tams ham MeeOM&nerorhtm he mmeins olhe Pavement Pereonalhamalminthe
mnYWe h the real well a dwlroyal by Me arwneaon process and canna a Material after cremation.
Nnby audh o Pine View Crematonum
n W cedilla%the nmeW of the NuuW.
p OPTIONAL)
game hereby auMoNa he named funeral diameter to prone bar Miami to ea esti aNn by an aamare
rc assured neeW6ary In Me opinion W the funeral direct and W amend M4 her topmvla M.comct rode and
aMre of slash aama ,category.
FINAL MSP0.41TION
Tay Oman wane imd to moeive Me cremated remains W Me decamed Min Me crematory e'.
Nana,Laune Bellinger
Addrem'. 103 TmOna Blvd, Unit 3 Jupiter, FL 33478 Phone 581v758-1940
M uemalyd mnei WIIMdlspwad of so :rmMyfd�Cmad -
lfN any member May pecnan a can rim had eke paewabn afro ammbt n m.
Pine View Crerratonuht laautimV ghrepacsesslond
Me rameinm W Regan Denny Stieford Funenal Home byde2.my
my"w we
In person orby regiYena mw. Janet Marion Werbldrw
w .Ma l
W Iss6t(Rev. (AW Poighl
qe ion for Cremation and Disposition
nmmmnd the drive remains are nm claimed with 130 den muem.uon.
Pine View Crematorium may del of are remains in
."''sawn
an Ineinanal manner such as W licensed,
OREIMTON CONTAINENORN
glandi ONEMIM fdlawlny
Regan Denny SraRON Funeral
An um to be uxtl as a•Ana'n10r Kf tl9OBma1B0 rnmairrt has been WttbeHtl M1Om A.-
and is described as romp:
2G Me undermm tMt tide um he Ion¢mar to had ndanma cnmw,d remains, an additional nand coal mar W dead far a ",
II CXR
An can a had wit purchased. Irwin understand nm n lb an a WMased or aherwbe adi
Pine View Crematorium will place the cremated remains in
pa.acmwn
a rigid bnpary d-artanar for delivery.
This Authorial rand was provided by Mutely M. Bulich was executed at
w amwe
Regan pantry,Stafford Funeral Home
y r e
53 Quaker Roetl Queambury NY 12804
m�+e.s wr
and is signed by the Nneml reactor as wiEieu to he reecual
been he"received a mmpleted¢ry of new Austronesian Fmal.
mad pareca lIMntleatl endow laps tin parsanbl in cdndei a disposition,was W signing and aumveration Farm,m gs)
to end accurxy send aampleYnese M 1M and ca an contained In and Autlmdxatlon Farm and autivtrelel gw berpoing.
slarradtnp 171h aural Augurs ( 3
Launhe Bellinger
yesnae
103 TteBana BNtl. Unit 3 Judger, FL 33478
Areas
va1NF89:
WUMy M. Bulich
aaw+avmronuaawe vm
10661
Janet Manors Mertalow
Ise+o.�.t
WStBB6f lflev. 0lQo1 Paged 3✓3