Loading...
Eastman, Richard G Pine View Cemetery g Crematorium Quaker Road Queensbury, NY 12804 (510) 745-4477 or (513) 745.4476 FUNERAL HOME: . _,_ -RfUGE)-___ _.._._._. RETURN TIME DATE E TIME REMAINS ARRIVED AT CREMATORY: _ . -- -.._._ RtO=Ay NAME OF FUNERAL DIRECTOR OR REGgI$TEREO RESIDENT DELIVERING REMAINS- NAME: _._._.____. TYPE OF CONTAINER: F�MR PLACE OF DEATH: (.1 ESTIMATED WEIGHT OF REMAINS & CONTAINER__. _ I1Af PLACED IN HOLD: _ -� �- & y` PLACED IN REFRIGERATION: _ -- _ .._._.� OgTF OF CREMATION: _ -��- a12 _ TIME STggTEO: &r AH TIME COMPLETED: PLACED IN RETORT: `pp}},�I -- �ERECRE RETORT p IN WHICH REMAINS WERE CREMATED: DETAILED REASON FOR DELAY IF REMAINS WERE CREMgTEO MORE THAN qB HOURS FROM TIME OF ACCEPTED DELIVERY: NOTE: THE CREMATION LOG SHALL DE RETAINED IN THE PERMANENT FILE OF THE CREMATORY, Pine View Cemetery and Crematorium 21 Quakel Road Queensbury, NY 12804 Authorization to Separate Cremated Remains ru:eml some -mg.TrN -- ------- n :,r_63�llnC�1 1Y1f13 a --------- uwe.amnrmZ die .al:.ratinrI Or d,C cmnIzlvd :..u:unS of --------- pwc rnn6cr ag.ce :o hold LamIeSS, indemnily:mJ derend Ilm Ikemin liame I acma:orium as wdl a d.cir rcl.ymWiltatives, Ilu . nd :µy:llist all diiinu, babili:io or (tailI es whaisiscm M:i<L may Multi l mill this :uuLori..liisII Sian awre63LL,E_[L� -_ -- -- - - cGmMnry oneml"'' ----------- -- ---------!IRIm w...halt New weak$Win FEW r DIVISION OF Xy�'3emwrsq Division of CI a, Cemeteries a e'randilmaxa,ze Authorization for Cremation and Disposition late AUBwN "Form most ImComte@a and apnea emar to mli ry Mremains tin anmadW. Data. Aug. 16, 2020 Number: �b Garetuy Namx frikeysial M addrave 71 lev a f1t o bur PI 0 . i18D`pana: ei r CREMAl10NISMIRRE RSIBLEANDFINALPROCEW. Ctnnalbn Is caned ON q plspur fire,plains aua de wig and the wMdrertmldirg ma amens into am onaM v.Tae LAW are seaward m Intense are and name. m Mat ami llama WIN IrcimI and wnwme invariant eastern IroaM YM a " whim are all that rat l) M WI after uern n. FdM na membrane the crematory We tare red o eflorb to massive At of the,mans aM em,m MBIl fmm IM as bw chamber.M1w some minimal d ust and sawaxi van IIMty the aft eehl m. The cermai ww gig mte im idental no action m Md from am and the wul'mud and iwern l malmlal wit be dlspoeed m r 1 as mo any law. TM cremated remains an be memallcalM puNmved?nto smml pieces and placed Into a sandalwood container or um. Cemeteries remains assembly am"l ri duntil no maple Impmeni Is reacpnisame am smi tiaw. OPENING OF THE CONTAINER The uemalory now rely own the m iainer,hoi the rummaged human me alns in limited dumsmwm.led,No efrm the sever fNe dettesed or to ensure that nor merribi encicsedv.Thch mIght, jure email a,or damage the ummtaypmwp N human remains are dolivemd Ina uanmineria ldt is not amsed,lrccrcmalbn each ar mmmonig or rental caret,Me canonical ram requm man me Me IMN o moved Into aw,W container barer.It meapts the m aiI mawaywogota cddamr or Memafer or mmoval AN remains win M unduasel b eawN Sand Wit M pore In w,ary.ham dlgriny and Nerand. anOi�N of D�99E...` Name of Dea.med: Richard G. EastrinanMan S5 s. Widowed Lxi Kravn Petrme: 119 Buttermilk Falls Rd. , Fort Anne NY. 12827 Plamaoeah same a above Sees. IIMM OF Age 79 yr4oe 01 /1 8 11 9 41 Date of Davis: 0 8/1 6120 20 Eaenamd weight J"lu Dmaamamerevmmworarin wnim remalm uNlMdalrverm. Florence Casket Co. PERSM IN COMIRCH OF DB SMO (Pmamnl m mid of daPoaMan,(p}(p{QVE cIIM/dbwirgf I elam the dm¢naol yW of the decreased d Ua ma wet Orwdmninautment sewed pursuant b Walt H"9 Los Reason 0201. (9Mee have no rnowlesew the the da'eaaed easNed avrtlntal iatnmanl Furman NoPublic Heath Law Semen chat or a vary 2namg dlreahre for than his Minton AN his m M rg mad IM9 are the particular)Mr'In9 prkmTy under Pudb Hmlth Lew Seclkn 4201 and here the Ads m aotMdm cremation 0 the remains off ma de W. MrMa mlmonehlp No Nan demand lsa folw . Richard G. Eastman onews it MS-16% (Rev. 08415) Page t of 3 Authorization for Cremation and Disposition Onaed here/M�e x✓buys boreal OacrpWn: SOW 1. Apemen 0e¢iBnaleEMrmitirg panuBtlb PudicH�M laxSxOm dZJ1(3): f. TMauMNnq apau¢e: 3. TnaaaMnle dnnnrya panne.: 3. A So l rOiN egnMenymrstlegewtlnn: .1. P surviNnq parent 5. A¢wt+vM9 sidlnB eighteen y¢g9dbdaM1Wkr; T. says partners)mounted Ms)ei9Meaiy®red mas art y, erenWbtoaM1ara lntMmrale aN VTOI✓are Goaestln rtlatlw¢nlpbtM1e Oa:m¢n: d A coureMldorreEutlarydt0ereltlg 0. Adue Mess or recal r W aMntyo has a presssmaiHndur"et pursoeMb Pudic Hetlm Law Sect nd20sear 10. AdIPIM Mason a county en assayof tminuOMr Iw he purvied ban"resume woSurmen st courtatement Prcw0lrt Al t0a PaePlay er420 wM is acYingmbMdltlbe da�sen nE Wwllre naalelawlllln sMmmrN pursuaMbPubllcXwM lax Sxlim dMl(]). ( tom/ NITHREEoItle/dbvnrlg) ® ll freer arms 0 et this body 0 lM EnN5e0 code W WNNna bmysy.beat pack.Fewer cal. retirement Implant. Of lea 0dauire and tha1 any numb casualty news remorM bw to Me®nulMr or bu Adywmdw Form. Failures b nmow MI share Poor b Proceeds,may m y result In Harm to ne cnab ss central pu ry and! © 4E i earn and Instrltlkns Mva[een mean to Bruce K. Mason. 12261 regartliy IM rareytl d"pdsmal pepo-ry or usual Mind a ads,M'n any perm)slming beoxw arytsmy halyard Me dei%assay bge¢erve. Pipti is not nopowdo for Me exceed of pnanal Manor Awn me oMltiM he mom My remains a has Ilewase0. Para lXema Ire In Me cnVnhe her msure Ma mmalmwin be dals"d by 0ew n Am prmaas and cannot ms relAemtl mbar cannabis. � ^A Me hareaOy WMea �ltE unl to aremm the remains aum daaaad. Fill DISPOl new port aaammo b crashes Me vandal eirrulre a the Mideast farelM pearWwyIs: Name: Bruce K. Mason A6 : Isloner 51E-639-5252 They Gurnal.angle d deMmM MII be diseases of as fakes: Return to family. 11 M are remm the person reared sale nary not iMe pa¢eubn of Me am remdm. �ALusEJ barWvbadbie'w pm.m.ana demmamb Mason Funeral Rome by Mass' rn `Pao` y In per¢mwb)regwea maL Richard G. Eastman COS-10961(Rev.0fl'15) nwww� Pee 2of3 Authorization for Cremation and Disposition ® KC Ii liewsrentl that NOie anathema rd palms]within 13065y¢Waennown. P JE✓CWI may al pow as the remana in an oemeawe manner,s acx as by warning. ' eu.md caEYAnoxcoxru ( di f ONE or me thickp) i � yy M um In the mm as a anbinerrw Me uwnalN remains i hem lwC+mdt lmn Mason euneral Home art 4tlsrnheha Wlwn: Solid Oak with Deer. IM1V a uMandntl IhL i(Ne urn h ko¢mN b 14tl tlw mlire uwMM mman¢,m MLltmal rgN mnleiw mey Ca u¢s1 br tlsliery. M M un ieMyd WrNo¢/f�1. IAVe um1biabrq tlul Fm um'u Wntu¢sdw Wwm¢e provlCe] �u�� ✓ will plxe the convert resmne'n a hgiE ldnp09yfonlarslor Otlrvary. 1h6AUMwketlon Formwapovlhetlhy Bruce R_ Mason. 12261 we,mai in Mason Funeral Honre aaswaft' wM Fort Ron, BY. 12827 on IS ni Ey the Wei director a woness W ds execution. .ev mrvW Me i received a ampleled¢qy of this A W M idifi en Eorm. has perswr1s) 1denuMG MWw know the rynodsl to sound ad BepaY11 who b/stenly ads AulMl:atlon form afteci m he sommy W comgebnsss of Vie Infatuation consisted In this ArNroshembon Form and autl standsi am brepolry. apt 16th e.ym Aug. ,2d20 ,may Keu'1+ Gr r ma. 112 Buttermilk Falls Rd. , For[ Ann. HY. 12827 is add- nmasmnww.. Vw.. WaNISS: Bruce A. Mason, Richard G. Eastman oOste9eitRev.ON1s1 paSeD 03