Eklund, Henry E. Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4478
FUNERAL HOME: _ ___
?gSFW- /(8.ut.kqrRETURN TIME
DATE 8 TIME REMAINS ARRIVED AT CREMATORY:
NAME OF FUNERAL DIRECTOR OR ERR EECRIIS�TEERRED RESIDENT DELIVERING REMAINS:
NAME: _—.. _�—_—_. KU CASE
X J
TYPE OF CONTAINER:
PLACE OF DEATH: -- ql
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER__,,.
__..
pl-0CED IN HOLD: ISO
_.. ... __
PLACES IN REFRIGERATION:
DATE OF CREMATION:
TIME STARTED' /_90�_TIME COMPLETED: _
PLACED IN RETORT: _IM,. _MOVED: p— �q_m
RETORTX IN WHICH REMAINS WERE CREMATED;
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN AS ry0U4S ry0Ug5
FROM TIME OF ACCEPTED DELIVERY;
NOTE: THE memgTION LOG SHALT BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
DIVISION OFF�M�B
,�f��EtYDRK Division of ror,�......Par,
gavuemori'A ..on
groulaw Cemeteries Muspy,NY 12231 age
T�Ph�.(518)Quality
,,r,do,my b",
AuthorUation for Cremation and DiftipsDalifflon
Thus A�o�F Edge mug W=M�Find Falling parmar he members 0�IM her C�OM
Dam AJGj 18, 2020 taftittl / 713
C�=�N� PINE IMENCIFFEMAJORIUM
QUAMER ROAD QUEENSIMURY W 1280`6 pholl 518-745,41M
0 E=M FFN
C!m!"==0 Orm thel 9 tf Name hand Ther container haddiner thi smadern mm,a
they are gbiW�to moral East and flarry, The beat=it ftM tell matter anded antitrust,Formych n a=g
Fail am all her Fell by,�ml c�� it th atonal From mor common
Forlowngamnsidler, me Formacres vall Oka reassymbe afteresto rearess,all China beffrounied 0 KM
member but some minimal dust and aredures Fell Wish be left bound, They comentery,sell examined small and foreign Madrid ader
11 he�m�
the remains Ford the andeental and fol mmmi Fail or d�0 as arld"Fraft 4 the The�m�remains" had Fiji
dowerreed into small Prectin Ford planymen nam a nominated ocgWIw Or Und c��in Illegal am P"Ve u as
gandle f�mea W scrimmages as WkWgj flum
OPENING QE THE CORDENER
The MM=�may M"W the conagger hall thas ar-margal human ream nine in Im tied Fordidearearrom. soon as to OF
Fuel of The attracted or to enable mad Fee reardarded 15 symbol Feel ml injure Factories or Ormarrie the deal protest N
human nernal am dWWO�in a countabower"job W net suftbW for dradmitior,such as Formal or M�l Gargalli do
cmmw�WIN �uim met they�im be�late a gleaday baseball behom it accepts the rernmrs. The Grambe Fat a
comearrear OF The trandar or harder of remains%d[M conduchad lagme a wtm�and sell day done i n product.wth damm,add ms�
IDENTIFICATION QFd DECEl NARMED
HENRYE EQ-UND taliall
Name of Demanding!
41 IFFINTHER MEDN'Taftyl DR CHESITEPTICIAl Alftl�
Laid��msF:
Place 0 Dead.41 PONTHER MOUNTAIN M CHE�T�.Ny 1017
sery Elm Elriliftal ED, 01104/1936 Fom�Fill 150
Determined a in Mech�wm My"N reveal
FLORENCE CASKET COMPANYINCREMATION CONTAINER? CARBOARDIFIBERBOARD
PEMM IN=bM&%Of 011
(�(5)00�ao$p� �GIVE d�"�W
zcouz� I scheme,ande me de��aftert of dre�domW�in a A,a agess,l�OM�mandeact W Public
��Small 4201
GR
— Me more no Ifteraord ise Feet ares d�succeed a serum instrument purFMrt W pW,c H�M rFFF Section 41rrl On a
Fall containing dimerames,V me deparearron of his as her Famous;Wit em am Par dameare, We",preed,under Public jdgjft Ludy
Section 420 1 and have the n9m to audience��Or W�urmMoMhipW���"
mi� HENRY E. EKLUND
Page I ofa
DE&Iftegifftl 04120)
Authorization for Cremation and DISPOS ion
Number
2 Nafi Colone)
_ NumCe[� Oexrptiort SPOUSEM'IFE
I. A person 4eslgnaW In vmtilp pursranlb PUEgc mill lax SecKn 4201M)-,
2 The surviving spouse.
h The wrvlvm9 domestic pare[
5. My Sari child alghmen yeve M ago or colder
A A surev,19 parent.
5. A sumwng sibling egmeen years of age of Older
S. A IPMUIIY appointed Even n',
]. AM parsonp1 e19hben Years Wage or doer entitled to shi In Na etleb and Me,laab doaM In mout'Immlp To be tlereeee].
& A duly appol near Rautiery WNa g MO.
9. A doe blend or relBYve wlq my;Manpowr a whole sUlemeM Wrauxl m PWk HMM lsw Set 4201171;
10, A tllaf fiaral ofiWr ofa rUUM/or a pubF adml mauxx alpgned Paul 10 ded Suncgift 5 Court ProNtlure AG,
iM. My Other peiem wed a for M lxhalf of the haweaM aM wed hx exe-ubtl a wiOan MemMv Wrouanl no Pudic XeaM
Lave,Eedan 4201(7),
�/,��µL MREE WIN)kWxu�
y't WJ,hereby afirrn that Me Way W Ile,debased aces nor MIMIn a daaery. laMery Nov. poxnr ceu, rzalaXlive Implarl
a retliWNuntleY¢¢arW Nat airy such motel Je savers r¢movar{norto Me axecutm oflM1is AUMdnv4on Form. Fallunb remove
Move Name prbr b cnmaEm MAY msWl In hum by are cmmWb and crematory gAOnreL
y/ `Mea nrah lml =ns have been given b uAMES P. MCDERMOTT
regarding the removet of arty pumnal pmpeM or otMr Min Wval vi WY parer wi NNox a any f Nmemler of me
PINE VIEW CREMATORIUM
demaeetl wlstas to preserve. rc ram
ie not macensove M Me removal of Ne al Items hcT IM rnnbinerwhem Ne remains of Inedeweaed. ParaomtIbme NXinW
/j�C/Malbur mwmrna remabu w4u b.awlrey.a Ny Ibu emmeddn prdceas.M ovnrmla remeed nwrbanatlon.
f/ c of hbaby numerous PINE VIEW CREMATORIUM �a
rw.p bsrmrabmaramslm MMe Musua.
Irml OGTICNALI
Mare MreNV aummlm may burned bmral alrecbrW povla tm M111I b and uenbtlon q an albrnN
maro and
n c aiwmn u inthe opinionWme lumnl dlrMor,aMWammo mb lomtbpovoelNe corrMtume
wereo of m.ndb mb W. remnmrv.
F NAL OISPOamR
Thersm
pe rod a]to examine may rem remum Mnwdesuewrhbn as aa'nabtl ie:
Name: JAMESP. MDERMOTT OR EMPLOYEE
morass. 9 PINE ST CNESTERTOWN.NY12B1T Phb8: 51B4842811
The aSMtl rbnam Wb6eW MM bedp WaMloaa'.
nb am rwsd^tl'a poxn memo#de aces not We pcuaevA W W abneledi ranWm.
PINE VIEW CREMATORIUM is aftha eed t"m ceawsal'n W
me remand b mNTOMMDERMOTT FUNERAL NOME.INC. 0y a&rvery
m�wwwm
In pascn orq regMaal meiL HEWIYEEAIUND
gw.xsri
Pp td3
OOS199&i(ftev.M1201
Authorization for Cremation and Disposition
'f0a&me auwmreg
U III uMersUnd mat If MO remain Bm mi Gymed µMin 120 Weisaamlm.
PINEMEW CREMATORIUM
w..ur..cy tuM3BWw MV9 tMne in
an Inelnamnk manna, AM as by suffl ne.
ClUBMATION m uwe
Qm�ONE ft In01
,/ MYmmeaYneawemmMna rordea.,Imed rwneiw law seen UmMw%tmwi
am la ceBoldee aBldl�,: u> I /9dS'�
IMIB UMemsW mal lime Ym iBlm emtllb NNdtln YlWiss pynHp tamgylB, angyWi4nYInyE CM1&nymeY EB YeBWMWWyry
_Mum iarclYet Wncl�al I umwYmWgelowumNWttliweE or W wpmWhd
PINE VIEW CNEMATORIUM wYl gaama pemapd remeim In
rzsnuoewn
e aye Mary mmNner rw eMlvew.
Thin AUMwsm ban Farm MG wm+ded% JAMES P. McDERMOTT vss ymuW al
mmwry
dARIDNM•DERMOTi FUNFR4L HOME WC.
✓w+rosrwvr
B PINE ST CXESTERTOYM,NY 13817
w.anae
and Y signed%tln fivptal Jw]w w vaNees la iln meoNon.
mass Nw DOntiwe a mmONled-0Y in that AUMwlwtlm Form.
This pert iai binBnW Below WI Ms perionlq In MI W"basalon,wain try WI MM AuMMmtlon Form, atlwpi)
0The accuracy and dwnplNaren Mday IMommtlon cwMained In ties Aulhorintlon Fwm And autlwNels)the Foregoing.
Slgned base 18TH day OF AUGUST mp
(AURAL EKLUND
01 PANTHER MOUNTAIN IXt CHESTERTOMA4NY 12817 +�
dismiss
A SP.JAMSMES P. MrDERMOTT
F�+mvTmrmru.r
1]33p
HENRY E. ERWND
ornor�i
DCSt8B9!(Rw.011101 lasipi