Matraw, Patricia I Pine View Cemetery & Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: __ YNISMOK
' - - --.._.._._. RETURN TIME
GATE B TIME REMAINS ARRIVED AT CREMATORY.
NAME OF FUNERAL DIRECTOR OR RELRISTERED RESIDENT DELIVERING REMAINS:
NAME: ._..__ _._T1+IL-"u✓ ..'.S.QFII`J✓I _yyy�.�p�W pf�
TYPE OF CONTAINER:
- .
PLACE OF DEATH; 33D
ESTIMATED WEIGHT OF REMAINS & CONTAINER__,_-____- Zf( --
PLACED IN HOLD:
PLACED IN REFRIGERATION: __
DATE OF CREMATION:
TIME STARTED: ,__ 7D ._TIMI COMP3LElTS0:
PLACED IN RETORT: Q_l0
RETORT A IN WHICH REMAINS WERE -CRREMATED: ___
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 46 HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION WD SHALL RE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
KEWYAl ORK Division of
°" Cemeteries "Wrom^°r°^°^^°`
Tw:pr'owMINo °�
Authoriuten for Cremation and Disposition
This AMoniUtlon Form must bo compleNU and signed prior to delivery of hem incefoorrcrnnal
Dian: OgMM20 Number. to O
Crematory Name:nnmiom Chairwoman
Address: 21 O1wks RpQ QU Ouq,NY l] meand. (51n 715-4477
CNENATION 18 AN IRRE MIBL AND FINM.PROCESB.
Comments mmW OW by pricing Me remains of the decesed and the corinlnu holding Mew ai%ntu ammM chamber where
May are subjected MiMenu That and Nme. The Mat and namewtlI inclwmto and Cd Um everything murept boom and mafal.
which are all Mal will be left after nemanon.
Fdb.Nng corrosion Me oemafory stall take reasonable efbrhb remove all MMe remains ale other malei from the aemedon
drambH, but Same mlMmal cost and rnldue will likely he left demand Than uematory wall selwwR iMgenal and foreign materiel From
the rwnaim ale Me Inadental and Meign mMnel soil [e diepABdINea required by law. 1Te oemaled remeirevnll be meUely®ly
pulverised into small pleura and pletcd men a designated oorthun vo Inn Cram "mnalm MIAMI sre Numerical uMll no
sung frpmaM is recognisable as skslwl nsum
OPEN NO OF THE CONTA HER
The oemahpy may only open Me consumer holding the unchemebd human w nsin limited arcumabrrea such as to w himn the
oen0ly mthe deeased or m ensure that no machines is enHtted which might slow employees or damage the crememry pmpdty. If
h undran remama am dMivoed Ina co winner which is not suitable for Crormnon such as stamen lot or shimuskat the
rti al all require Mat the demurs he moed Into a au liable conMlmr bef he n accepb ua remains. The opening of a
conbhrer or Me transfer orrwhoel of remains Mn de wrduclM Mere a armed and well be done In All"M dignity aryl reaped.
Ing"FICATION OF DEGUSED
Name M Oeceesed: Pebitla I. MW" Mal stems'. MMal
Last Known Address: u)Nunn Mmk Bt, Cohen NY 12M
Pence W tteM: 1N most Maim 51..Con M, NY 12M
Ses E3M OF Age: 27 DOB: 0F/3411W Date Of Dash. O ID021 F54matM VMgld fix
Deecnecon Of caskNwMainer In which rename all be delivTed.
(t mabviallmWellmaou m* MIstMMS Aurora NMd and C8WW CAme DOCUMN
Oilseeds)mcmbd M O1a mm. lndaf ONE of Me nlnanwO
eml are Me desgnated agent Of the wKwd ddmigm W In a sell or wrNen imWmeM ekKNed pursueMm Public
( La
Hall Law Sel 4201
A�9,1A"_ eyes name no knowledge that Me deYa rid exxNetl awiltl instrument forward to Public Hal Law Section 42010r8
well COManirlg dlR@ans For Me diapOSNon of his or her moment and Our are the pereced hating ghoMy undo Public mail Law
Secdm4201 and havethe Pointer authorise oemancn crime remains ottMdemesl.tl. MyfWrlNanemnlN mtledeceeaed man
rolrow
PaNtle I. Meun'
DOS-lMN f(For, Ofln15) Nlg¢ 1 NS
steel
Authorization for Cremation and Disposition
(in Man Me art Mail
Murat 2 recession: Swlcn aware
1. A person dngnabE in wrilMg Nomura he peac Pool la✓3xtlon 4201(3).
2. They M®ral!past,,
It. TM surecng domestic coal
3. My surviving mild elgMeen years of now or older.
4. AsurvivMg arem,
L AsurvlviN si ring algae!n yearer of age or older.
i AlaMully aggimen guardian:
1. My Woo l egnrean wean of age m older emitted b snare m do sable and anatomic coal in rekrmn snip to the deceamedl
r. A duly aproi mad barman of the estate;
s. Aclose mend or real who May measured a when Miam m pursuant b on am Health taw become 4201py.
10. Abrief hmrsl onlsr of a caunty or a Pool d administrator appeal member to the uncommon!s Coal ProaNura An;
1ge. Amy ohhar pvsm who is aNng on behalf N Me deceased and who has!resided a whose formal pu Manor b Paoua Neann
Iaw Forman 4201Ol
�(Jppgl AU THREE of Me bpo mbel
T S]L11Mk nereoy aficm tlwt Vc Lady of Ne dx:.esed deer M mMain a Oadery. W Wry paIX. Wait mdiwcove implud,
aredlmyve deem and"any wtli matelots were removed pnwbnre vmution close ArMoncNon Foam. FYlurabrw "
tlesa Xens prior b Gamatlon mBY result In Nrm b tlw nameimry and crxnebry person eel.
`k fr lib affirm that lm4mtians N'R R o given to PaBn I. C&smare
begamng Va remain of any Nreonal pmceM or many My p ofval when any NMcn!hiffng oeiw or any mmlry member of the
d sad wmhes topr ei Pascal Cremaloriwn
wee
is no[rMpomibk boner 9novBl of peManal inems hem MefArNMttmhom 1W reme�ne mMe WmesW. PweMil lams eRM IM
Coaelmr or xM Me meeting or W dMnal oy Me cm Oon perms eM mnnW be nhNvel NMcrwfwlba
Il be" Mod oree Roe ce mmmm �rxrq
b awmss m ownahm of Me dxsuM.
FINAL MB ITIM
no timed, lxMb rarmor Me cemesd remand of for Monsanto VnuansalaY'o:
Name: R I ammn
Mond; TMode n Avenue,Cenmh. NY I= Posner ol0)B51g2B5
The diamond] metes of commend Mil W dk/Oamd of UMail
11 fc aM ce®m IM1e perem nem]eEwe der M 1Ye pmxxxke ci M.emnalM cemvm.
mreNw Crematorium he euNched b giver OF
Me estimates to Wool Flneml Hernse. Ind.
4.ivwre..rw�u by dMMOY
to ptrsm or W registered mail.
PaNria I. MMoae
poS10BEf(firl gol m+aora>.o Prool
Authorization for Cremation and Disposition
� Murat the ramwnyl
A LWJe ondernane Nat it Me rename are not cement within 120 days or transient,
minevex Cremsronum may dispose of The remsers In
an IneMevame manner, wm as by scanening
CREMATONCOWAINERNRN
fh�f dl COVE dme MmwingJ
An ism 10 As ua s me a wmalnerMe Me uemffid moraine has been purchased man Densmore Funeral Home Inc
andm desuided as follows.
Mind understand Mai the um is too small to need The sere amended remmna, an seasonal nest consumer may I used for delivery.
oR-
anumlanmyetpurchaled. IMreunderstmamatifnoum la PUr aeeaorabnewleepwdea
Preview Cramer wall pare Meamended nommens In
a held mM cwnw
temporery communist for di
This Authorization Farm was pmaleee 0y Robert 1. Densmore mn+enevmm was executedrt
Densmore coastal Home. Irc.
T Sherman Amen 3R3s, Corinth NY 13 Owy"mnon)
and is signed by the hi doetlor as wlbnass to Its exe ulad u
IWO have Moved a completed copy of M5 AU orbs Form
The yeadderns)b the MemoreIaendfetl b of Me Infomralow Islam Me retion COMaa) In dentromed elntllb ArNmrh Fsming this Authorizon Tom,ad suNmlxeiS)drs(mseobnlghat
ry anfearlessness
land August e
51gned ON day of
Rooed G. Mottos
nvao vrvp
390 Wear Mega St Carol NV 12B12
Ajppm
densis
desse
WITNESS:
Robed I. Densmore
e;Imi
rm�vm�mw^N
hisser N~
PeluGe I. Manville
DO&18984(Rev. =151 Page 3 of 3