Hayward, Tyler J. Pine View Cemetery 8, Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (STB) 745-4476
FUNERAL NOMEe
-- B-- -f"M- - _ RETURN TIME: _DATE a TIME REMAINS ARRIVED AT CREMATORY: _
NAME OF FUNERAL DIRECTOR OR REGRISTEREO RESIDENT DELIVERING
REMAINS;
NAME: .._.
TYPE OF CASE q _ 'f3)
CONTAINER: tea- J'G u Corr
_p 4
PLACE OF OFgTH: , ._ alQ� !� y
ESTIMATED WEIGHT OF REMAINS E CONTAINER__
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CHEMATION: _
TIME STARTED: COMPLETED,
PLACED IN RETORT:
HMO VEO: 8 . )D
RETORT A IN WHICH REMAINS WERE CREMATED:DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN q3 Y�I' I
FROM TIME OF ACCEPTED DELIVERY: HOURS
NOTE: THE CREMATION L06 SMALL ME RETAINED IN THE pERMAMENT FILE OF THE CREMATORY
Pine VICW Cemelcry and Crematoriwn
21 Quaker Road
Queensbury, NY [2804
Authorization to Separate Cremated Remains
F0110-A Home - ----------^e---hu"i;g------------
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pwe amhodm :he sCjell uion of ale ncnntea re,muos of
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pwe rn:iLcr:,pree to hda h:mole,,, inacmeiln:oa Jdaoa (he 6acin omocd acmavnimn 0 well
as dKir MWOCIl x:ives, elon, alela dlllsl :111 dlinu, li'a)ailicv or aalee ce wlmmocvcr which mxy
,usrA Imm tllis UO:orii mo
tt ,
r - a.a5tae
///-��'''III ON OF M i W 5Yb
At PORK Division of DIVISION OF CEM SERIES
TEO O C PN
OPPORNNIM Cemeteries 99 wrommi Avenue
Cemeteries reaches, 511047461
Authorization for Cremation and Disposition
TWO AYNro MWn aware mlalbe wmplebtl and signed paartadMi y of nemalnsfor cnmetion.
Data Auguat 16, 20M Number. V
Central Name Piney Channel
A s: 21 Quaker Road clerestory, New York lgBd Plans. 518-746-41417
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremation is carried out by Plating Me remains o1 Me Mwn 1 am IM cornmeal holded Me remain[into a cemation chamber Ware
Ilreyer wNMe WIntense Maand Mme. The but and flame will iclmraM and wmuma everything except bone eM moral,
whicbareall1 WIIbeleftabrcnmadon.
Following vem3tion,the uemalory will make reasonable aflMa to remove all of Me remains and filler matarul kom the common
chamber, but some minimal dust also residue will likely Ive at behind The crematory WII wool Inadental and foreign malanel Imm
Me remains and ma mtldenMl and for malarial vnll be renewed Was required any law. The unusual remains art be mMlanYdry
puNamed into small pews and paced into a designated rownerm um. Cm SWmnalm PmMllyanpulwdm unBlna
singlefragmFMIs easternmost asekWeOl Masus.
OPENING OF THE CONTAINER
The cremMay my only open me wnMlner holding the unuemated human remains In limited drwmatanma such as to rotation the
already of decreased cued or to ensure Min no mstedal is endound conies might niure em orkers or damage the crematory removed. If
human re r aw am delivered In a container which Is not sortable for cremation such as caremoolal or rental create, the
marry WII "Was built Me remains be moved Into a suitable container reform It acosets Me remains. The owning W a
consumer of the samara removal W rematnswill be condutlell before a witness and will be bane in arracy MM1 dignity antl re[wG.
OENnF CATION OF DECEASED
Name MDocument_ Tyler J. Hayai Marital Status: Maker Momell
.
Last Known octal 12 Pearl St. Hudwn Falls, New York 12800
Place of Dear Bun Roadn and stet. lem MoHN a6i
Sax, Elm OF Age 24 Doe: 03-19-1996 Date ofocem. DB-1°-zozo estimamanyignh 150
recomparm aCazkNmm&der in whitll Mm rn r will be delivered.
Florence Casket, plywood corrugated cardboard container.
WROLOFOMMSITION
(Po=Ow In awontr wisiv a i ram' r1ONEMtlw M1Nbwlrg)
I mNJa are IM deugnSW teem WMe dKs designated in said orwiften Inawment executed cuum WPublic
Hearst Law Section 4201.
-DR-
GA and he knowledge Met the measured executed a wrMen instrument Masuant to Public Heeled Law SeGcn 201 ore
all mMainYq dna9ons fIX Me discussed W his or,her remains and IMm are the personts)having real under Public Handle,Law
Sedw1201 andi hevedro dOMloauMeve Memation elide remains Mthe aeceasM. MYIWr nlesanshlP rotln devaead la u
follow
Tyler J. Hayward
DOS real n es. wrz0) Pnge l ag
Authorization for Cremation anti Disposition
limo mme um bowing
Number redemption: A ewvii parent
1. A person Merrill in wiling protect to Panic mail law Se 12 Iph
2 The evolving domestic
L. The surviving aomdathpdMW
i. Any
shil vine CMM eighteen year¢olage or dad[
a' Anownegg Wrenl',
6. A wrviNnreiemb eighteen
Morganeera of egewoMan
s. Aperigapromteeenaroiaw,
T. AnyWrson(g eighteen yeenm af Me ge Or older series to sham mtre estate and wno mare dowsers reMr nmpmme eeaa.ee:
B. AA aYIi Mod or Massa gas Personal a v eo statement
10. Asham fill officer of awanly w a inch:aeminummor a _ gunuanitd Public KumagaHiciffir i
aCouldosedun
108. Any other person who in realandwho has executent to the SunopasWom tPm Mmt Ad;
law$Bden4201(T1. on beM1ellellM1e eBCeasee end wTd has eveWleeawdlen elalemenlWrsuenl]o PYEIZ He9M
lt�IAL{� HHREE draw refbmmp)
CR 4 Mreby affirm that me body M the aemnea does nod contain a summer po""Or Ewer rat. rWvw-,time imgenl,
orraegYgral cone and Mat any such mahnals were ren W poor to ma manages olmie Augotlaebi Form. FUluno MMo
lM—nteItems Met to octal may result in harm W Ne Co nutpy and RemovalpmmnnN.
y i We eMrm Nat insNglons have been green to Claire C.KorearFe
regarding me removal many personal Wright or sham mine Of value evnich any pawn segnlg below dram frmiy member a Me
dencomed wishes to pool pmevsrerrpatory
is net removal b Me removal of pramal items from the anmler or from me�wnrns mire derewed. pmmal Items left In N.
container
ham hembm demon¢ Pine vow Commonly
i womm.l.N.ramaim min.e.uae.e.
�ropnoNAy
mee honest sm,odn Me named furem macro.to Pmulda for Perform to and.moral M an alternate
eannee we cn afro.m<n nmiwy a Per nim of the moral adml and fo amend this form w Pmwde Ne mrmm name and
FINAL DISPWITION
ThepersonauNmised to fe ime vemeled remains of me deceased turn.Me vemeMry is;
Name M. B. Kilmer Funeral Here
Ay s; t25 Mel B1. 5ouN Glens Field, New from 12WJ prere: 51&7958118
The Remal remains Of emend evil W disposed ofasAudi
BYdtl Emeriti Chanel
If her any mason the Wrson named above does netMW Wewaaa mine wemated
Pire Velcmmmory
m.�.waw.w is aut w Mrs pdd wnnaion of
the remains he M. B, plmw Funeral Home
in Meson or by"Kilmr mag "'"wev 4delivery
Tyher J.Hgwyd
re0&1Bill(Rev. Gill Pepe 2 W 3
V .-
Authorization for Cremation and Disposition
(e1Me g)
CH endemmunit1a181MRmama am notclaim NwllMn l Mdaysofearmation
Pine View Cmmelory
w v My disease of the hareems in
an mMmm W manner, ham as My swmng.
CREMa fle y,�
GN`�m to the used as a conlamerM Me cmngled remains has Men purNeeed from M. B. Knew Funeral Home
art is deccwas tit Mw"e a Cultured Money Black and V.TiM
IMb uMe M that if the um a tW nnY110 hold the entire vMpted remains an add2Mal rind wn ner may the was!MdNVery,
(f
An um M net yet puMemd. Ii uMmWd Mel it no um u Pahlavi or a Me mprovided
Pine Vary;Crem4ory MII place the cremeled remains in
rvnaonerr
a d8id temPoary central for delivery.
This AuM agm Form Wed pmaded by Claim C. Kaepla was exerted at
M. B. Kilmer Fmmml Home n�.ra.adx.xr
138 Main 5t. 5ouM Glens Fells, New VOM1 12803
and IS egad by the funeral Interior as whineee M its execution a
IMp here maxi a hampleled copy of His Au Mr zl mForm.
The penonp)IdeMBed belgv ISM1n bs"m (s) In conbal of d6pmlem,vfio by signing Hb AUhM1nrdn Form,small
to the accuracy and complWnsss of be Inferma4an contained In bN Aldermaston Fomr and auMormeia)the foreg0ing.
Sign"Use 18 day 8f August t0 00 .
Casey Heyward b
aini
91109oyre Read Albany New YM 12205
Connive Lord AAe
8051alker Vifird li NewyorkIM7
WITNESSChin :
0102 C. Kimminsf l��
0193 7m
Tyler J.HeWrsd
N>rwa�a
DOS188bf(Rev. 04W) Pepe3M3