Ball, Robert L. Pine View Cemetery & Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: _ —��;
- RETURN TIME: _DATE S TIME REMAINS ARRIVED AT CREMATORY:
NAME OF FUNERAL DIRECTOR OR REGRISTEREO RESIDENT DELIVERING
REMAINS;
NAME: '-----
_..-
TYPE OF CONTAINER: )I4 - CASE p
PLACE OF DEATH:
-----...----------
ESTIMATED WEIGHT OF REMAINS B CONTAINER_ -
PLACED IN HOLD: ._-.. 3,0
PLACED IN REFRIGERATION;
DATE OF CREMATION:
TIME STARTED:
----'---'7" TIME COMPLETED: _ )p; _
PLACED IN RETORT;
—MO
RETORT pIN WHICH REMAINS WEREREMATED:VED. �_- [).Po
DETAILED REASON FOR DELAY IF REMAINS WERECREMATEOW
FROM TIME OF ACCEPTED DELIVERY: MORE THAN YE HOURS
NOTE: THE CREMATION LOG SHALL BE RETAJNEG :N THE PERMANENT FILE OF THE HE CREMATORY
perpetrtaed of si
�NEWYORK p1VlSlOfl Of
EOTPAPTOER OiFV NITy. Drva MUERIE OneC .... Pl ..
Cemeteries
im Washington PI^
D001
Telephone:1EM1474a226
vocodmini
Authorization for Cremation and Disposition
The AUMW "M Form mwt bet completed and signed g W aellvery admaital C mOon.
Data 8/11W020 NuMwc qq7,
Cremeery Name: Pine View Crematory
Copper Rated, owenWun. W tIDDO 51474E-4OTT
Address: Phone
CREMATION IS AN IRREVERSIBLE AND FINPL PROCESS.
Commit Is tamed Out by plating Na remains ofthe demawd and the cerium hoping the remains into a cremation acronym wtpe
MevarsubleceeNIntemehintanc 0eme. The Maand Name will Imlrrmae aM tonsume everyhing except bores and m 1.
Fol�which areal)Matwit a IMatbr mmmrea
chamber aemarim, the crem st anry d residue
eke cell day teFe be remm'e all o pa remaine and other mtrial andfrom
foreign
n matcournes n
M eremai Out d t emmlmM al at and foreign
m will nkwar be Ice uteri o The crematory,coin separate aced industrial ane rMil be mathrom form
Me remainsandthe incidental andMicon mateesi son be disputed of as repuireaW lees. TM Demoted aware Mil be ue ina ry
sWveefra into small
is
pemseM gas a rote a e rmuss. a mMeirwra um. Cnmaea nmaine ganedlly ere pulwrlstl uMl no
single fragment is rxoBnivbe a¢¢keleel tis¢w.
OPENING OF THE CONTAINER
The crematory may only open Me mnlainer hi the umcremaM human remains in limited mornaenms, such as to confirm the
wieners of the answered or to ensure Mat no material is erlowa which might many employees or damage Me cremaory, property. if
human remains are delivered In a con ewer which is net suitable for cnmaaon such As common lot or rental Ge b4 Me
Mabry will repuln Mat they MmsiM be moved into a suitable comainar berore it accept Me dmtlm. The omning a a
mnwineror the transfer Or occur of remains will tBwnductaa before a whness and will be done In prise yr With rignhy and respM.
IDENTIFICATION OF DECEASED
Name a oeceasea. Robes L. Ball Marcel statue, Divorced
1178 Glens Falls Mountain Rd., Lake Lucerne, NV 12846
LM Mawr Mantas:
wemaoee Saratoga Hospital, Saratoga Springs, NV 12866
Sex: [9M Or Age 57 Doe 11/17/1962 Date Of 6/2020 EMI y hL 20O
DexApeon Of in whYJh remains all we aalweme.
McDonald basic cremation container, no interior
PERSON IN CONTROL OF DISMO ION
(Perem(s) In poor of apesfion, NaGt ONE 0IM Io'bwvg)
console are Me designated new by Me instan tad designated in WII or yoncen instrument executed purauaa W Public
Health taw Section azot.
-OR-
FF� WJe here mMMedge Mailed his or
eaemains an women are
the pl sonto havng Public Heath rry under P u am maMZOt we
tall nleini1aa hive be Meaoposyone h OoerremaineaMsOflhS themrmn(¢) havrmiadoinshipWPudic Health IOW
sedW
semn4zm am mueMe agmro ewtpaze vmneeon owe remene Done ameaaee. gfoa.raaeonanlp a M. a.uoaea e..
folew
Robert L. Bail
005-1891(Res. OW16) Page 1 of
Authorization for Cremation and Disposition
MzNw Me Removing)
b �understand that NMe maintain Ma rM command
wln 120 Jays a uemNbR
Fin U CremeMry
mu»ucN+n may dep MMe remains In
an Wholeness manner, aW.LupyeMptlnp.
CREMATION CONTAINER/IIRN
(R�r ONE of the ltlbwlng) '{� � � (' 11I__ �
—(IL—An on An um to me u a memer kr Me rremalae remains has been pu pe rtwe hm Rry ✓IP a xre r Yll & imp
and is described as tdiows: h{tI v M2o vI
li Understand Man it up um is too was to pad Me walks moment hemains, an emotional pela odmemer may was for Mirary.
An um his ra yapuraanm. wvw aneemum MN era am is paM.fed orarerwdse pmviaea
Pine Yru Crarnalpy
will plereNe pemateJ remains in
w�wpYlbN
a So temporary wMamer for Jalivey,
The Americanization Food "a PrAn Jby Patricia Miller wasexewkeat
Brewer Funeral Home, Inc.
b Chomm St, lake Lineman, W 12M
and is apM]by the Nne21 diremor u wiMesa to m exaction,
meus.w
lY%pane roodv a Wrested mi a min Andwarkaaon Form.
Tka pa (s) lamabad below IYam Me"heorms) In contra or dispassion,who by denims Mis Authommtian Form. a US)
to tla accuracy and camplaMwF d"Imia ma dmn mntalrpd In MN AUMdalntlm Farm and awhembu lq Me himeoing.
Signed Min 18 day nt August xp 20
Jade
,roadaa, nI
2n Hgwe Rd., a Wxeme. NV 128aa
W Perrone
: rw a�mwm a�tinw �
Paestas Miller
pt2i05
Robert L. Ball
DOS 18984(Rev.O&16) Past
Authorization for Cremation and Disposition
Otwaf dom me fiareemwl
Number 3 Desonfirm daughter
son dra ignated In ashmse Wrarmnt W Pudic Hewth tow Setlkn 4201(31
1. TMe ;
g spouse
The surviving domestic partner
3. Any surviving child egelxn were of age or older
A A surviving parent
S. Asunivirq&Mn iigMeen years of Me or drier;
r. A lawfully appointed guardian:
ymora ( te ihWGaryofl a Me or older armed us to Share In the estate a nd who ers Covert In relalioni M the concerned
B. A io 1
B. AdiMend Or shave who haseveWW awmenstatement Pursuant to Public Heats tau Section 021
10. A Chlefferal drum of a courtly H a public administrator appointed pursuant to Me Surtogal Court Praedure Am
108. Any other person who is adding on banker of the removed and who has demand a written statement putsuenl m PUNk North
toles,5eetlon 401(2),
(brands LAIL MREE afire ldbwng)
Who moody affirm Net the body of Me dshousabod does not contain a battery, deal Wdt, Power¢II. additional Implant
or mdioa five desice and that any such materials were removed pnp to the execution of fins Ammorlawtion Farm. Faflum w m ove
MiIttems poor to cremtlbn may mull In ham Were Cnmmory and cmn gpnarmet.
IAVe atrse that inetruchonw have Been given to Paldde Mlles
regarding the removal of any personal efforts a other Ming ofvalue whrJt any person sgmng below or off,family member of he
Pine Ytew C smaluy
deceased wishes to preserve.
Is not resWnsidle extra removal of Personal Mm form the renounce H from the remains ofthe Manuel wWponeIts In SN
rendinerawilh the remvina will Wd9 yW "a CmnWen proms and Cannot be retrieved again CrmnMon.
p Pine View Oren
t% IlWe lroreby euleONe
tGenwrram)
No Cre Me remains of Me deceased.
FINAL DISPOSIMPOIN
TM parson eWMhed to recena Me comment remains of the decoead hcm the amtaKry as
greatest Formed Home, Inc.
Name:
26 Church SI., Lake Luweme. NY 12M 516 27"
Afghan, Phone:
The cremetM remeim W deposed will the disposed W as feel
burial in Luzeme Cemetery
If for any mason has pMwM named above deals not Wks po ire a Me overall rervers.
Pine Nap Cremalay
is mdWlzM M give removal of
Menmalnsw Sell Furenl Home. Inc by mostly
Puvammausv
in Wr or by ragiftered mail.
Robert L. Bell
DOS-1898-1(RM.DWI5) rv.�om Page 2 of