Bynes, Robert Stickney Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: ..__ RQS
_.._..._ RETURN TIME:
DATE A TIME REMAINS ARRIVED AT CREMATORY: p
9[v q
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
Llwo
Tiff
NAME ._ . ✓-Li`2 ___r�l-N __CASEp _
TYPE OF CONTAINER:
PLACE OF DEATH:
ESTIMATED WEIGHT OF REMAINS B CONTAINER_ --
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION:
TIME STARTED; __ _ _�:/pen
TIM¢ COMPLETED: ._Z.wn
PLACED IN RETORT: _ _�;�e
RETORT p IN WHICH REMAINS WERE CREMATED:
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN Yg HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOG SHALL DE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
WEReNYE OXI N Sb e
N RK QIVI5101 Of orvhslonoMES
�qrmlwi,,Fll
TY_ emetenes 9 m1 Aenue
nN" wen
5 e:Rtnen
Authorization for Cremation and Disposition
Tllb AaMalaatlon Farm must IN compM and signed prmrto dmNery of remains National
Date: OBI11/2020 Nurmer: 9il
cremaory Name:Pine Yew Cremelorium
gxms:61 Quaker Rokid, Querearsbury, NY 128M Phone: (618) 146J411
CREMFT MAN lfl EMISLE AND FINAL PROCUS. _
Charraction W cement cut by pal Me of may
etary and the wiftne,holding the
may am submitted
d to Mmnae heatand PameinM i Iwtand dame wilinamearreb and co remains chamber nsume adarything ea furls am l
Mich are all Met sell the NX vNx Managed.
Fdbamq =n Wn.Me crematory will take reasonable offal tin remove all of Me remains and OIM1er material from the oemlOn
clamber, but sane minimal dust and real will likely be Nfl brand The memetory will means Incidental and War materal heat
thin remains add to incidental and foreign material will M di nkmad gas re9ulred by law. The Cremated remains will the meMeni®Ity
surfaced into small pieces and placed I=a des On Orangwood un. Cr ted .malt.ganmailyampelved uWM
WNW hagment is mnnWbie Me akeiew metal
OPFHN OF THE CONTAINER
TM barrel may only open the container holding the unn emaiM human remains in limbed circumstances,such u to¢ "M.
idanday of the declared or to made Mat no malmial is radial which might Iniwe employees or damage Me oemal p%Rny. If
human surname are danm lid In a carman which Is not sul for anomalous such as ceremonial or Will Main.the
bry will require Me tin mmahm am moved Into a suggests container Wom it accepts the remain. The opening m a
mrememamer or the Murder or removal of mmeil vnll be wMu [afore a whines and fall be done In privacy MM Mill and respell.
IDENTIFICA� OF DECUSED
Name of Demand: Robert SNOkney Bryinges martial stable: Merced
time Known pydram:319 Broadway Fort Edward NY 12UB
piece Md Dk ed,Fon Hudson Nursing HOMe, 319 Upper Broadway. Fort Edward. NY 128M
tax, 0m OF Age: 86 DDD: 11Q8I1933 DMdD 08118I2020 EstMINMwdght
D ption of wrkaumnuiner M whtli mnaM all Madlverad pp
�-� 4 Q-L ® MAGI
f(Yawrral m wndmrarmaprMon, xr�m 19NeV am""i
I small am the designatede¢m otMe declared Wholnebi in a wl or wTMen imndmem ern WdWdw m Pudic
HnhM Law Sa[tlm 41.
-0R-
INh hate no knoMedge Met Me Miamievewled a armed unusual purnmerW Public Health law Sagion am1 Ora
iwN Lag Mane r ton the important of his or her remains and IM are Me mramlH hNig Mo ily under Puma Health taw
Saban 4201 add was Me right to anion crematbn he Me remain of the denamd. slyfli mMonship btM MMnead W Me
MIM'.
Robert SNGcnay Baynes
Paget of3
pOg-189blfRev.OM10)
Authorization for Cremation and Disposition
Nnrdrmmdrerrsnnw)
Number'. 2 combustion. S
1. Aarsonaesgnslea lnw NpbmrMto Pudic Realm Lew5MM0201(3):
2. The sui,iong spouse:
U. The summing common partner.
a. My wrviong mina ei Mars M age Or odd.
l A derives parent',
S. A sul sibling elphosen seam of age Or okbl
T. My pemorll egg een"am of age or okb entiLba W sham in me same and MO Ware bosest in norms ip to me ae¢ewa;
S. A duly appointed f1d iery of the estate;
8. A dome Mono or resume wM10 has executed a mean eW t sumuaM to Public Ham Use Smi4201(7);
10. A chielfiwl or of a nuMy or a public administrator epgvrXN Puma nt so Me Surrogates Count conceded M1:
me. Myotherpersonwhoisa ngon WMff& ode 2a aNwhohasexeated8wrinenamtemeMpurwaep Pudk Rwnh
Law aeewp 4201y)
(rental ALL THREE Of the fcWWV)
Mod hereby affirm that me body of me decimal are aql contain a battery, battery pack, power Wl, redioe msell
a retl'w 1ve deuce and mtl any such mderiak were remvred prior to me maution of this Audmd"i Form. Failure to nmwe
Moore prior m cremation my red un in harm ro om CMm aM prmu Wrsonrl.
Liner affirm mat mstmdour have men given in WWel M. Bulieh
demand the removal a any"m academy or dameWrp of matt will any"room Wnaq ham or ury Hmld member of the
donor wishem tar brews. Pine View Crematorium
is ma responsible Par tam removal of Pomona[idrm"in me dddl or horn Me remains dne erased. Parsarl Ions lee In me
small or meat does remains will doe drtrdyr by ins rnmWon prong army mnnM his respond dam common.
Ri�l' uwa hareby authorize Pine View Crematorium
T_� m..ans'�a mnamale the e«wr wins
ardialOPTNNJAL)
air hereby amhorW me mooed Poo l director to praised forgives,to and internal by an aMmab
ad", n drmr necessary In me opinion of tam NMmt director. and to spend ink kind to govir the comet name and
address a such amended)c remamry.
FWAL pISPp811MN
T Person ewhonzr to around me boundary remains W the roomed them"crerrmme? Is
wine'.Regan Denny StallorE Funeral Home
53 Quaker Richard, Queanebury NY 12800 vdcne: (518) n2-1114
ram wdeUaxywin be aiepcsed ear IdW2:
Burial — Union Dametery
sew are r.rmmxpmenrw.a.tow.air nwfeW pmerekm wine arnmardrdrim,
Pine VlBw Crematorium is someone to gme Possemicn of
msremaimm Reg Da rry Funeral Hma liv a eyaeery
e StMottl
In"rsa or by aepietetey mail. Robert SBckney Bryne�tl��
Page 2 of 3
p0.4-189&f(Rw. OSRn)
l Authodzetion for Cremadon and Disposition
l ^ I�thyne wawo
IAft underWnd IKt i who are not Wimed wo 120 erys W uemuWn.
Pine Yew Crematorium maydegree Man mm
an ineVevabb mentor, so as Wumsmg. netic i
LREI MN ANERNRN
ru ME of(he overseen)
An um to be unto as a mnto far the cmmMi Romaine has Oven purtliamd fro
SW is essential as Mines,
Ilene understand Mat it um isle small hdd un a2n doamnaµl Real an addMbna' ryB wnWrcr my wad MQuery.
OR-
,AALsh um is net M pumlmed. Lynn undandaM to sm um is pudawd v aMsrvion pmNM
Pine Yew Crematorium w it peen me comment himairein
w.aemesni
a Nod lempwary cementer to dalway.
This Aum aH Fdmt.as ao+iued by Wendy M. Bulich was eraMedin
Regan Denny SUford Funeral Home
53 Quaker Road Ou derobury, NY 1280a
and is vend by the funeral dlrMcr as nibreu to ds wecwon.��N
We have moment a Wmplatad tepy 0Mls Antum9rbn Fees
The paAen(at Identified bale Islam Ms persons)In conbol of testimonies,who by signing the AwFOdiatlon Farm,adeagaf
to Me acarany and semplN ness of the Intervention sonWred In Mi Amanuenses Form and witnesses)Ne ranpolry.
sgned the 1791 day of August .20
Roberta Lee-Brynes �Q . ;,� >4NSR.3^✓
rm.e.n..ee. A6
P.O. Box 1021, South Glens Falls, NY 12803-
1yrINF89:
Wendy M. Bulich _
m..+umrw.r,..ea.y
10441
Rabart SEckney Styli
w..asrm
WS1 BBbt(Rev. OaRO) PaNal