Austin, Richard Charles Pone View Cemetery g Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME:
- _, R,DJ ____ . RETURN TIME: _
DATE & TIME REMAINS ARRIVED AT CREMATORY: —n, L%-ft
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REM g,
__. . _,D sot.---wL -nfl� r,Ih..--_-
NAME: V� e
_ __. HIC L1�5IT1U
..__ CASE p -,
TYpE OF CONTAINER: ___ ,uLl - /I may'
_-gyp—'PLACE OF DEATH; __ ___
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER____
7of lilt
PLACED IN HOLD; — —'
PLACED IN REFRIGERATION; _
DATE OF CREMATION:
TIME STARTED:
IWWJJ-- TIME COMPLETED:
PLACED IN RETORT;
RETORT p IN WHICH REMAINS WERE CREMATED:
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAT HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL DE RETAINER IN THE PERMANENT FILE THE c CREMATORY.
n pace
OperMvnl W EY4
NEWYORK Division Of olvlslox apcmEMEre�1Es
TNI OF
pyPORO1NM Cemeteries
001
Authorlution for Cremation and Disposition
The aWwrr nForm most be C«npbbe and eNlnel poor maNary Mmaleb MnwrWm
part: 0&IftQD2o Number. 131
Chambray Wm:Pine Vbw Crematorium
Amrtss 51 Quaker Road. Queansbury, NY 12804 Plmm: (518) 146-04T/
CREMATION 18 AN IRREVERSIBLE AND FIN" PROCEW.
CMmeton is UMM out by placing Me remains aMe sac eW and Me chu mor naeirp the remains Imo a «emBepn chamber whom
whiare all VMS
nearaM Mme. Tm Mt.ne hero.x1n mumrMe vM corunm.w.ryMlrM ..mpt bone and nMvl,
Wore am allsell be lam Baer cremker wa
chamber
bid wine ,tinealdwocriminal d random
do rtawnabb eXmh to remove all IX Ma remains and Mnm material and
Smile,ile vema4on
clamberbandeminimaldu61Bndrignmwill IlkdybeleftoW T ie " willnhe co imand rchrodenelarts wi ad matnammmm
umrameilIane ueintleeMalanecedintmatenalni� be whrmin dor a reC by law. me«enemarenamewulbemedvnio
puMe¢etl imo smell ro [wets plead mro a Whom
wMainer«um. Crvnube ramslm penanity ere pulveozM unN no
abgle hvpmeM N rxopnirdbm w ekilgl tluw.
OPENING OF THE CONTAINER
mecemawymyonNopenmewMa,rernad'agmeunmre tehumanremainsin IimixdarcumMance¢, suchaimwnfimrme
(human oflMeeramdmNd en sure Maliwmebrixb endasMwhlU mlgMlnlureemployas ceremonial
iris Nobel rypmpBM_ N
human maim ere dellWrye lnvcaoMlmrwM1lcM1 le nalauXabb brcMmrbn such ea cenmonlslprenYl ueMllx
oemvbrywill rpulre Xultlw nmfinsbemoved InWasumblaand aopera and na be
drshorty' . rd deputy
mand Me
mnbimr or the o-enamror removal M rtmamiwNl be rorwucme before a wimeev am w1II be aam In ptreav, MIn agnryma roped.
OENTFICAMON OF DECEASED
Name IX unusuae. Richard Charles Austin Mery Sbms: Will
Last Hawn Address:11717 Spotard Mal Ave, Various, FL U292
Pleura Dram:Glens Fells Hospital, 100 Park SDeet Glens Falls, NY 12NI �ny
sw: ®M OF Age: TO DOB: 11IO7I1949 OabIXpaam. ORIi&2020 EeNmrtd water,
Dwb kellmmti mrin 7wU Mar cD4dkj(D
PERsox IN CONTRM OF DMPOSmpx
(Person(¢)N¢nhd olMiPpslCon InrTal0.NEdtln NWw+rpl
I mMYe ere the msipnamd agent of the discounted designated in B MII«wMm irnWMM etmnNee pureumlm PWb
HwI1M1 Law Sectlon 4201.
-0R-
IM'e
have noknoWlMmmed asetl wami B wraen in¢bumeM Present k Public Heats law SMIon 4201 or
an Meinirg direNlohe la Me diapper on of his or her remains and It ere the pertoma)Moire pmdry under Public HesMh Law
n4201 and have the nght to au odu aemalbn MMe remain of the decease. MylOur MlaoonshlpWN MOSSe aas
bllpww
Richard Change Audi
MS-18M f lRw. 044a) Prept
Authorization for Cremation and Disposition
pmmlrvwn mauummwl
Number 2 pesc dhon. SWi
1. Aperson Eagnated in sent borrowed to FundHNN lea Sinum Q0113):
]. The ewHlrg spruaei
as. The surviving domptiC peMIX:
d. My widening calm elgnmen yMre W Je or aeon
4. AsumNryperend:
S. A SUMOrg doling eighteen years of ape or older.
S. A uninly appeared!gueNun',
T. My"hours)esMOen years M age or clear areal To shaTin the estate and wMbmre domme in rehaliMlMp to Me drrxed:
B. A duty apparel fiduuary of Me mast'
g. A close Mend or relative who has execukd a shown enactment pu mito Pubes Heater Law Section QOl(7)',
10. A chlet fiscal officer Of a county,or e public admimAredur awmisid pumand to the Surraget's Court Prc¢dure Aol
Its, Arty ONer person who is atling on beMH Of The decased and who has evewtd a wndtn Mlemed pursuant m Public HBgt
bw Sweden 4201(7).
Ai THREE a the mlbwrvi
Wye Mreby after gal to M!y Mee discussed di wo drawn a aal betty Pack, power mil. Mbwedi Imi
orfackboatowe dean aid that any such mederlalswere removallpbroMeaewOM Ones AUhandr on Form. FellunmrMllMe
tacobmspoormore Mionmayroute In Nmrmtl crememryendcnmamrypsmonnel.
Wye ago tMlnehucMns haw:been grown Wend�Mi Bu icM1
real Ma removal M any fersuiW pmpeM or dMr dMng ofveWe which any Mrsm toning bases Vcoy fancyt Of Val
Macanese wslres to wel Piro View Crematorium
is had operated tar to amoral M pool hems frown this container or from the remains ofMe decimal PmorW Mon to In Me
container or van Me remains war be destroyed by they Ransil process and cannot be Moderated after cronabon.
IILW hall announced Pirle View Crematorium
ic..mywbw to cnmak the rantam a 011 decewd.
(feW OPTIONAL)
LWs hereby author Me naneyd meal obeyer to preamB for datery as and everyone by an alternate
carefu , If tlmmM necessary in the contra atmtumM director,and In amentl this form to provide Me co met cameBM
Ndms asuch ammat Churr .
FIXAL DISPOBRION
Ton peaseinattention]mrmes Me aemtlal romans of the cannel from Ne antibody,m:
NweaRegain Chlinny Stafford Funeral Home
Aroma: 53 Quaker Road Queensbury, NY 12R04 phmr (518) 792,1114
TmoemaW mnalm Mmmmlbon Oe caspml MarelO.m:
Return rofamily
If far Bny seam Ma Mowi rtml always deals nd tab pcvnYon d Me overnight mmYm.
Pine View Crematorium tnuMladmOiapmwsMa
the economy t Regan Dena StaffofE Funeral Homo by deliary
in person or by regaeml mail. Richard Charles Austin
(waenimatp
W 181)dhf(Rm. 0,k1t0) Page W5
Authorization for Cremation and Disposition
In Mablbwlns)
IRW disbanding1N1tt1M remains ne redd8ime0 shown 120 days
Ncemetion.r .
Pine Vim Crematorium mayddapon W do renWm In
an am newahw manner,such as W annealing.
0RIMAMON COMAr aPAluao
tioNEerme roww;nel
An um N da lead as a mmajaw N Me managed nmeim has Iran PuIWBM Mass
and is daemxd as follows'
IAse urMsrend Nan 0Me No N an wren to had the grain umWed remaM.an addmonal dpa designer may Ee used 1aentries.
V\� An um N M yM psrlaxd. Me understand Met it mom is puahased a Whisnae Monded
u Pine Ylew Crematorium wyl plere Manremaned mnelm in
a rgatempa+rY mnmrxrMadel'r � o.+n
maAUNwV000n fade was proNded ey WenCVM Bulich was erecuged al
Pieqrdn Gen y StaRortl Funerel Hama
53 Gu lker Road. 42gainansidwy. NY 128N
and N signal tay Me anneal dismiss as whmu W nse swan.
INN,have salved a sompiHed wily of gas Assessment f omr.
no
Mesaauiaalaand cool pleten Islam
ofthas Inkersesulon COMAIwadin m4 Aunenaa eForm sew IM01 We)Me Form,
inng qal
ryas p
spas Mo 16th day August 20
—A—
Joan Au ti 9 ilCi
ma.o.w.mm 3�
3011 Lek Geserrile Way, PIONEER! Stallion, NY 12W1-
ydTNEW .
Welly M. Bulich —
n•�+m.+.m..�wae.aw rv.a w
0441
Richard Charles Austin
COslnBsdiBev.0eR0) PNe 3M3