Petit, Marguerite Marie Pine View cemetery g Crematorium
Quaker Road
Queensbury, NY 12804
(51 a) 745-4477 or (518) 74S-4476
FUNERAL HOME: Aft?p)
-- - ------__._._.__._ RETURN TIME:
DATE S TIME REMAINS ARRIVED AT CREMATORY:
NAME OF FUNERAL m Z,05
DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
NAME: I_A-PF�UFRAE
- -C4EEp
TYPE OF CONTAINER:
PLACE OF OEATH:ESTIM ._�_�!•w���
_.-�PLACED IN WEIGHT OF REMAINS 8 CONTAINER_____ /OG PLACED IN IN HOLD: ,
PLACED IN REFRIGERATION;
DATE OF CREMATION:
TIME STARTED: __ _�. ION— —TIME COMPLETED: _3;OTfn
PLACED IN RETORT: )D pI�A
_ .-- 1__MOVED:
RETORT p IN WHICH _L REMAINS WERE CREMATED: _
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED ORE TNN 48 HOURS
FROM TIME OF ACCEPTED DELIVERY;
NOTE. THE CREMATION LOG SHALL BE RETAINED IN THE PERMANENT PILE OF THE CREMA OT av
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• Authorization for Cremation and Disposition "111111',wc<WMa
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This AUMeZBO n Form must be completed and aigmdprfor M "Arlify of remains for cremation.
Date' 08/172020 Number: 9e 1
Crematory Name: Pine View Crematorium _ ror
Morass: QuakcrRmA, Qudxmsblag,NYl2904 Phone:
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremation is canned out by placing the remains of the deceased and the container holding the remains into a
cremation chamber where they are subjected to intense heat and flame. The heat and flame will Inclnersfe and
consume everything except bone and metal, which are all Mat will be Will:after cremation.
Following cremation, the crematory will take reasonable efforts to remove all of the remains and other material from
the cremation chamber, but some minimal dust and residue will likely be left behind The crematory will separate
incidental and foreign material from the remains and the incidental and foreign material will be disposed of as
required by law. The cremated remains will ba mechanically pulvei into small pieces and placed into a
designated container or urn', Central remains generally are pulverized until no single fragment is
recognizable as skeletal tissue.
OPENING OF CONTAINER.
The crematory may only open the container holding the un-cremated human remains in limited circumstances, such
as to confirm the identify of the deceased or to ensure that no material is enclosed which might injure employees or
damage crematory property. If human remains are delivered in a container which Is not sultable for cremation
such as a ceremonial or renUl casket, the crematory will require Mat the remains be moved iMp a suitable
container before it accepts the remains. The opening of a container or the transfer or removal of remains will b s
conducted before a witness and will be done in privacy, with dignity and reaped.
IDENTIFICATION OF DECEASED
Name of Deceased Mannal Marie Petit Mantel Status: Never Married
Last Known Address'. 29 Martindale Ave., Hudson Falls New York 12839
Place of Death: 29 Martindale Ave. Hudson Falls New York 12839
Sax 6 Age: 60 DOB: 11/28/1959 Date of Death: 8/15/2020 Estimated Weight: 10016s
Description of caske /conainer in which remains will be delivered. Matthews Cremation Cave
Cardboard top/piywood bottom
PERSON IN CONTROL OF DISPOSITION
(Pereon(el in eontrd ofdind0mion, 01�ONE of the fave"mpl
I am/We are the designated agent of the deceased designated in a will or wmtten instrument executed
pursuant to Public Heats Law section 4201.
m I01 have no knowledge that the deceased executed a written instrument pursuant to Public Heats Law
section 4201 or a will containing dlredions for the disposition of his or her remains and ((.altimreCalaxrpeae)
Marguente Marie Petit
006-181 tMv.mnol wmearo.eeiii Peet as
I aml we are the pateon(s) having pnority under Public Health Law section 4201 and have the right to authorize
cremation of the remains of the deceased. My/Our MNlonshlP to the deceased Is as follow:
pllmdlmm me 16t aelow)
Numbeltt—I Desorption'
1. A person designated in writing pursuant to Public Has& Law section 4201(3):
2. The surviving spousal
2a.The surviving domestic partner:
3. Any surviving child eighteen years of age or older;
4.A surviving parent,
5. A surviving sibling eighteen years of age or older;
E. A lawfully appointed guardian;
T. Any persons) eighteen years of age or older entitled to share In the estate and who Ware closest in
relationship to the deceased!
S. A duly appointed Fiduciary of the estate; ]
9. A close Mend or relative who has executed a written statement pursuant to Public Health Law §4201( A
10. A chief fiscal officer of a county or a public administrator appointed pursuant to the Suoogale's Court
Procedure Act;
10a. Any other person who Is acting on behalf of the deceased and who has executed a written entemeld
pursuant to Public Health Law §4201(7)
fnif ALL THREE of the ldlOmog) owe: coil,
IM'e hereby affirm that the body of the deceased does not contain a battery, battery pack, p
radioactive implant, or radioactive device and that any such materials were removed prior to the execution of this
ve Mesa items Prior to cremation may result In harm to the crematory and
Authorization Fonn. Failure to remo
ore aW personnel.
r INJe hereby off an that sonar pions have been ghren to Mu a which
any)
Cassandra S. Maille
regarding the removal of any personal property or other Ming of value wM1l, h any person signing below or any fa of
member of the deceased wishespanic to preserve. lme connmre)
Pine View Crematorium is
removal
l items from
tainer or from
10In the cosible ntainer or with the sremains will be destroyed by Ne the
promise and cannot ba retrieved
tier cremation. p{ve View Crematorium to cremate the
4fI0t hereby supreme Immuvr am+l
rBmdtns Of the deceased.
FINAL DISPOSITION
The person aulhonzed to receive the cremated remains of the deceased from the crematory is:
Name: Crleton Funeral Home, Inc.
Phone: 518-]4]4243
Address: 68 Main Sues[ Hudson Fells, NY 12839
The disputed remains of deceased will be disposed of es follows:
remaA hll
if for any remon the pamon named ve tlor not take posse e'eul f to I e the dpescelseion of the remains to
lmmawr�wad p' V' C mator�_ Person or by registered mail.
Irw.nlmmeremel
Carleton Funeral Home, Inc. by delivery in
Mar uerite Marie Petit v.esims
werere fDaiwavI
ooslessu raw.total
(then Me lollowing)
'}—�yy-F�n I WO understand that it the remains are not claimed within 120 days of cremation,
knmwxg,wm') Pine Vice Crematorium may dispose of the remains in an Inatiievable manner,
such as by scattering.
CREMATION CONTAINERNRN
(brio I ONE of the Admire)
An um to be used as a container for the cremated remains has been purrlresd ! from
Carleton Funeral Home Inc. and is described as follows:
lMe understand that if the urn is too small to hold the entire cremated remains, an additional rigid whether may be
used for delivery.
-OR-
An urn has not yet been purchased. We understand that tf no um is purchased or otherwise provided
tmmw 10"n Pine View Crematorium will place the cremated remains in a rigid temporary
container for delivery.
The Authorization Fonn was provided by tronmi ue.emrsame) Cassandra S. Maille ,
was executed at poem nwe,wme) Carleton Funeral Home Inc.
Imneniwmeadenssl 68 Main Street Hudson Falls NY 12839 and is signed by the funeral director
as witness to its executioe.
lMe have received a completed copy of this Authorization Form.
The personnel idengfed below islam the person(s) In control of disposition, who by signing this
Authorization Form, aftil te fire accuracy and completeness of the information contained In this
AuthorizationForm and authodzNal the foregoing.A �' �I II 1
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Address
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Address
WTNESS: �(
Mark K. Parish
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Mirmuerhe More Petit
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