Siletti, Pamela E. Pine View Cemetery & Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (51B) 745.4476
FUNERAL HOME: .
RETURN TIME:
OATS B TIME REMAINS ARRIVED AT CREMATORY: Q a / 0 NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING
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TYPE OF CONTAINER: "EM
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PLACE OF DEATH:
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER
PLACED IN HOLD: FF�I IV�
PLACED IN RCFRIGERpTION: _
DATE OF CREMATION:
TIME STARTED: ,__, 9,IjMkF,,._— - -�� --
TIME COMPLETED:——
PLACED IN RETORT: —_ /D,uS
RETORT UIN WHICH REMAINS WERE CREMATED: -
__.. SL4FV QLU Pq
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN N qS HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL BE RETAINED IN THE PERMANENT FILED THE HE CREMATORY,
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RAW YORK pIVIS10R 0f grvlalOCram,
OFNEMETERMe"
STATE OF ` pile Cammnn Porn
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OpPgfreNlT'. CeR1CtErIBS Gb n
Telephone 15ffir4746206
viverdircryi
Authorization for Cremation and Disposition
This Aut Hzatbn Form must Ce completed and signed prorto detivery of remains toy cr tion.
Data OB11912020 Humber Tin
Crematory Name: Pine View Crematory �1
Addreu: 21 Ouaker Rd., Gueensbuil NY 12809 prime.
CREMATION IS AN IRREVERHBLE AND FINAL PROCEae.
Cmretbn is Carried out by Means Me remains of the deuaved and Me Cont iner holding Me remains Into a Cremation GwmberwFae
they are ¢uEjeded to IMenae Meted Pame. The NO and Dame are Nclnmb and consume everything except bare and n 1,
which an all that will be le after cremation.
Following crane n,Me monetary will take reesoname efforts to achieve all of Me remains and other material From Me Common
cna r, butsome minimal dust and Hail will likely be Its MhirA. TM vematery will eeprate inddentaleM farei9^ materiel M1om
Me remains and Me Inoter al and foreign material will be dispoved of as RyuiRd by law. The cremated remelts INS me mechaniGPy
puverlwdInto small Peres and pleadinto a designs Container"nor eremawlrenulmgomrnlyarepebmlaedanalm
single fragment is nooenbatae we skeMLLl tlseue.
OPENING OF THE CONTAINER
The crematory may only open the Container holding the uncremated human remains In limited circumstances, such AS to Cmi tag
merely mthe deceased or to ensure that no materials endowed whim might injure employees or damage Me Crematory PoPenv. It
human mmaMs are delivered M a contalnearwhich is net suitable for cmmsmn such as ceremonial or Named ueket,the
coormaory will reRutre Ma the remain$ MMoved laid a rumble container harbor It accepts Me m ins. The opening of
ntainer Other transfer or removal of remains will be conducted before a witness and will M done in privacy. with dignity and respacl.
OENTIF CATION OF OECFASED
Name of oewased: Pamela E. Silefti Marital Status: kbUmed
Lag Known Address: 22 Athol Road, Athol, NY 12810
Ross of Death Glens Falls Hoeprtal, 102 Park Street, Glens Falls, NY 12801
SUN: ❑M IN Age: RB DOD: 05I0511959 Date of Death: OWl MO20 Estimated Weigh 1C0
Mcrip en of msFeV¢nlainer in which remah5 all the dalvered.
Florence Casket deluxe container
fMXX CONTROL OF DISPOSITION
am Which,orowsN ,, MNa ONE Wage mWM9)
marine are the devemm ed agent of the deceased designated in a will or wagon instrument breveted pungent to PUNIC
Health Ian Section 4201.
dew ,have no knowledge Mat Me deceased executed a wrong instrument Fursuem to Puma Health Law Section 4201 or a
win Co aximry directions for the elensaion of his or her remains and Iraver are the persona)rotor ng priedty under Public Hwlm Law
worsenrzotandhave Menht ioauhodummaaonoftheremainsof Med«aased. W/Ourmmtionshiptorted easedwas
Will
Pamala E. Silefli
DOS-Is (Rev. gams) Page 1 of 3
Authorization for Cremation and Disposition
(mmn fiom the at bebw)
Number: 2 Newhall Surviving Sousushe
1. A ntlnotera a in writing Minimal to Public Imumb Law $eyion 4201131:
2. The surviving spouse;
2a. The surviving domestic"Mar,
3. any surviving dries mgh years of age or ade0
a. A Surviving parent;
5. AReaing sibling eighteen rears M ace or order.
6. AlaMmy eau auaNian
T. any peraonts)eighteen years of age Or older entitled the mare In Me estate and who assure aosesun ml mhip to Me da t',
a. A duly appointed Moday anM esreke;
9. A nose mend wrelalue who has eucated a krnel Statement pursuant ro Pubrrc mrste Law Becton 4201l11l
10. Ami¢I ISWI officer of a County or a public admen forear appoi reed pursuant to the SunOgata's coon Proxdure An.
has. My other parwn who is coal on twMu of dwkMkyc and who has enewted a added statement domain b Pmla Heats
Law Becton 4201p).
M I ALL THREE NMe geho inp)
Ind/¢ hgeUy seem Nat the body of the demanded deas not contain a barery, battery Oak, power cell, radicaclw 'rM lenl
or rediaeive device and Mat any such materials were removed pnm W Me execution of this AIMMaaWn Farm. Failure to remove
7FMine prlosto crematla d may made in harm to Me cMM Mry and Manuel pemonnel.
INge aKum that rehears d,have been given M Davv'd Alexander
regarding the removal of any barwMl property or other thing Of value wbinr any Mrson Signing Mimv or tiny f nn0y member or Me
amosm wishes Mpreeerve. Pile View Crematory,
isep not reomibb forem removal 0"real items from the normal Once the dealm of the decimal Panonat Hm left in the
M7Mar r arm the remains well M destroyed bytM cremation process and cannot ber affiliate!after cremation.
IA'M hang authl Pine ew Cremtory a
Nivo
M cremate the ramaMe M Me dweaaed.
rmselORTIONALd
ban Mraby auMOMe the named Nmral directer to MaylM her deirvicer to and cnmaeon ber an tlmma d
mnaWm, edeemad necessary In the opinion of the funeral director, and to amend MIS Mnn M Provide the correct name and
"time of such afteinale cmmMOry.
FINAL DISPOSITION
The further Nord to revive the cremated remains of Me demo from Me aemabry ie:
Name;Alexander-Baker Funeral Home, David Alexander
Address: 3809 Main Street Warrensburg NV 12885 phone: (518) 623-2066
The cremered remains of dents well be editorial Of me floes:
Return to family
9 fv any reseed the" Mn named above does not take p seon IX the cremated mmNM,
Pine View Crematory a Submarine M live pomassion0
Me remains to Alexantler-Baker Funeral Home by delimry
in peen an by relieured man. Pamela E. SilaM
OOS1 Bl IMv.0M20) Pape 2 M 3
Authorization for Cremation and Disposition
rnvnwmgl
INie un erstand Mat if Ins remains are rot dolma within tloeryaauemarion,
Puna View Crematory may disease Of the remains In
an'naturalmanner such as by emlterirg. roi
CRIfill CONTAINEWURN ONE aMe liskow )
An um to be used as a consumer fn the vemalee remeirc tus been puwvsea fmm Allekandar-Baker Funeral
and is adsorbed as folio"
All understand mat sue um is too amau to hold Me gross cremated remains, an a idtionel ryd container may IN used he Mivery.
.oa-
An um is nN yet Purchased. INIa wderMrM Mat a no um is µrchasee or otMwke wm'ieed
Pine Vrax Cmmet wiu place the cremates re atemains in
a ngie sanctions container for delivery. wn
rm.auawdaadon Form was ywie.e for David AlexarWer wwsexemN M
Alexantler-Baker Funeral Home
3809 Main Street, Warrensburg, NY 12885
and is conned by the funeral director as wblese to io ea'ecusel
Men have ano ur ad a completed aqy of this AUMortxasbn Form.
no pelwnlf)ideMiOad below Were the pares l in control of diepwidon,who by signing this AU mftn Form, anesil l
to Mat accuracy add canplateness of the isothermal contained in this Authorization Fain add seasonal the foregoing.
siglred into 19th days August 20 0
Paul J. Sileei
I, .
22 Athol Road AdhoI NY 12810
Adel
.ass saa.
WILME$$:
David Alexander
I.. ,
10103,4
Pamala E. Suledi
uo—+e.mu
Ws.1 BaB-f full cal coastal