Closson, Nicholas Pine VIEW Cemetery & Crematorium
Quaker ROad
Queensbury, NY 12804
(518) 745-4477 or (515) 745-4475
FUNERAL HOME:
--[N94SogA(Is— _. RETURN TIME
REMAINS A
GATE A TIME REM _ RY:
ARRIVED AT LREMATOfl T:
NAME OF FUNERAL DIRECTOR OR HCORISTERED RESIDENT DELIVERING REMAINS:
---- --.NAME: ._..
CASE A 9 TYPE OF CONTAINER: "� _
PLACE OF DEATH:
ESTIM
WEIG
PLACED IN OLD: T OF REMAINS A CONTAINER
PLACED IN NOLO:
PLACED 1N REFRIGERATION; __ -----�
DATE OF CREMATION: __ -- -- - -- - ---���- �---�
TIME STARTED;
P COMPLETED:PLACED IN RETORT: _ y�D�..
�'Il1L3-- MOVED: . . .__I_i0 �' 1
RETORT p IN WHICH REMAINS WERE CREMATED:
DETAILED REASON FOR DELAY IF REMAINS WERE ACCEPTED DELIVERY: CREMgT�W -� )LL�R1T.
FROM TIME OF MORE THAN 48 HOURS
NOTE; THE LOG __
SHALL RE RETAINED IN THE PERMANENT FILE OF THE CREMATGRY
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Authorization for Cremation and Disposil
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CRMAMN MAN IRREVERSIBILE AND FINAL PROCESS.
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Name. COmpenbmte Wneni Can
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Authorization for Crematlon and Ulsposldon
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VITNESS
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