Grimaldi, Anthony J. Fine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (51 a) 745-4476
FUNERAL NOME; ___ yf
- _N'J
--_.._.,_.. RETURN TIME:
DATE & TIME REM BINS ARRIVED AT CREMATORY: a"
NAME OFF FUNERAL DIRECTOR OR REGRISTERIO RESIDENT DELIVERING REMAINS:
NAME pyNl.yy /y,,,,� n CASE IF
11 aa
TYPE OF CONTAINER
_. m>r_ lei _G. Car1 Q aclu
PLACE OF DEATH: At Uplp � -------
ESTIMATED ESTIMATED WEIGHT OF REMAINS a CONTAINER__„
PLACED IN HOLD:
PLACED IN REFRIGERATION; � - •y
DATE OF CREMATION: —'-
_ _
TIME STARTED: _ -_ _ )GV(96Y1 _TIME COMPLETED: _ I
STARTED-
PLACED IN RETORT' �— Aft-
RETORT pIN WHICH REMAINS WERE CREMATED:
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED SIMORE THAN ORS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: t11L cNemgTION LOG SHALL OF RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
departmental
NEWroRK I Division of ONIs10X OF CEMETERIES
Oni poor
OPPORNXIW. Cemeteries reazMg nu bn Avee
Telw one-.1m5147PPO6
Authorization for Cremation and Disposition
The AuMo/i"Mon Form must be completed and Jena sandy to del ha y of remains No cmnanan.
DBla August Number: 11�
Cmmmo Name. Pine Vim ceramics
Addre ,21 Quemnftpad OuxnRq. NJV York 12004 per. 518-141nu ]
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremation is tamed Per by All Me remains W Me detested and the mnlaner raising Me remains into a cremation chamber r em
may are subjected to showed hear and flame. no hard and flame will imirenh and consume axryminR except bone and mo 1,
which ere all Nat will be late after cremation.
Following pemancre the vemalory ii lake rxsomble come N Rmwe JI of the remains and Other materiel from the scandal
chamber, bud some minimal dust and residue son likely be oft behind. The comments,MII separate Incidental and foreign adrenal hen
Me remains and the irindental and foreign medical will bealapoxd of as reTuired N low. The uesieted remains will W methodically
pulkal into smell pieces and Noted into a dxgnted container or mr OmnabdmmainsgamilyarepulvenmauMino
sinelafmgmemierecoenUblemebie la6Bue.
OPENING OF THE CONTAINER
The aemamry may aonly open the container holding My Internment!human remains in tinned ciramsdness, such as to nnfin Me
ideMily rkMe des sad or to ensure that no malenal is enclosed witch mot injure employces or damage Me crematory droll It
hum normal s are delivered in w lnor which Is not eWmbm for ammaHOn such as anamatrial an rental casket,the
m.m will require that Me remains be milked lend a euifable cOma met mot it acceptsexamine.thexamine. The opening of
come ry her or the transfer or removal N r man AN be c nduded bolas a wive and own as Whom nanny with Mary and reyna.
OENT F CAT ON OF DECEASED
Name of consul Anthony J. Denmark Medial Small: Matief
Last Known Address.' 1A Wheal stew Smith(N ns Falls.New York12EW
Place of Cobb: to ontral eel Drive South Giens Ford New York later
sex: Elm OF AN, 63 DOB 12-18-1956 Dole 0Death 08-22-2020 Eats eldWrkeM 60
DaxripMon of aakeswnl In which remains art he delivered,
Florence Casket, plywood corrugated cardboard container.
PERSON X CONTROL OF DISPOSmON
ory Oe)NanrM N repayment (came ONE or MeklbwNgl
I shared ere the designated "am of Me Norma a designated in a will or unXeni ovemen t exaeulef Pursuant to Public
Heron law soon 6201.
OR-
liters have no knowledge that the dK exemtea a sa en instruments pursuant to Public Hal Lee descent 4201 of
W mimne directory for the depositor of his or her remains and tree are the I"Mon(s)hi priority under Public health Lew
section 4201 and have the right to auNMzm memaaon often remansabe deaaxd. M/IOunr onsmpm Nedxeaaeabn
follow
Anthony J. Grimaldi
DOS-1BWi(Rev. Maki Page 1 W 3
Authorization for Cremation and Disposition
Tmert from me Ibf beWx)
Number R Damsel; The eurvwmg swuae.
1. A"man designated T wring punMnt to Fudw Hm lw Setlka,620l(3);
z. That passing spouse.
L. The surviving amended partneq
], Any survlvrrp thin eighteen made of age an ded,
l A surrrving parent;
o, A surminp sibling eighteen Ross M aged or olderl
6. A 4wmAy appointed gueMian;
L Any persoms) eigMsn years of age or older antlerb N share in To eNte and who,snare cici In rertnerstip to the deMSM:
0. A duly appeared fidrdh ryof me made,
8. AtlMe Mend or teas,ire who has Around a women satement pumuam W Public H"M Law SWIan4WI );
10. A chaos fecal Whom of a coumy w a pudic aournmerata apWlnkd pureuar b Me Surrmete s Court Pmmtlure Ad;
108. Any other pemon who is acting on behalf 0Me mdm,md and who has executed a writer statement pursuant to Puak Heats
Le„Section 4201p).
greallJ1^�IA/L�L THREE of me bAbwMg)
INJs hereby aRYm tied me busy of the mayddmd does not amend a bl", batlery I power till, mdsome" 'mptant.
or radical deves,and test any such materials were removed pdorto the eFatlon ofthis Aumwim4on Form. Ftllumbrwnove
f elamepriortocmmabonmaymoult Inharm Wtl cmmatoryanda Mrygr "-
Ii Were that in4wdions have been given to Claire C. Nmcpb uen omvww
regarding the removal of any peduchad property or deer thing of value which any pram signing blow or any firmly rrwmM 0Ue
dewas&l wishes to geRNe Pine Vim Cmmabry
re not mepanabf for me mmoval of"radial items from the antanef or lam me remarsoftMdxceead P Oni Nemeleain"
r wlm M. re MN W deWoyed by the re
m monarch Remains;and cannot de, after cmmanon.
An VNomr you ome Pine New Camel Nara'+
W mnmab Me mrdlM OF me
I�OPTIONAL)
Wu hereby amhonze Me namW funaml director to proviM for delivery a and cmmatlon by an elNn W
reMNo , Ndeemed nereeaary In the salmon of and,federal dinosaur and W amend this,form W provide Me monM name and
address of such aftrnaM cmmMry.
MML 01S oNT1ON
The Mason amend to Name the seabed remains of the deraaWd M1 thederMtcrY I6'
Name, M. B. Hilmar Fum al Home
Addreu: 1W Main St. Sevin Glen Fells. New York 1210.3 Phppe. 515TISb115
The vvnaad mmaiM of deic al vwll be contended of es lol
Regarded!W his was Mpew GOM di
If of any want Mc Fewer normal abwa Wes M eke pCu mafthe cue Wrema'M.
Pine view Chamber is sutivked W give hardware of
men Ins W M. B. Manor Funeral Homen� w Mdelivery
in person or W reysmM mall. Anthony J. Smir lti Pwr+wu�
DOS-18 -1 dres Owl Ppaz IXl
Authorization for Cremation and Disposhion
I�me Wgawi
—1MN understand Met fire famous are nm assured within 120 myemaremat pn.
PIM` WCremM may Meadow Arm assume in
an lnalduable manner, such As 0y assuming, ac.imrl
CREMATION CONTMNERIURN
(11i@.1 ONE of IM1e f lkwing)
An um to se,used as a consumer lalM assumed remains has Oeen PWdMW M1cm M. B.Kona Funeral Hone
and Is desmEed as follows'.
Wh uMem and them If Me um utw WO W Mk IM1e anHre comm ad rear an additional rigid consumer may to used KKd9Nery.
-0R
M um Is hit yYgYC11BW. INh understand the 0 no um is purchased or erenise pmAW
ne ulew Cuban" wig plan the asem and rer ma
a hiWamparary container far delivery mom- n
Tm Aumanhumn Form was prwidad py Gaire C. KOmpke was eyayled al
M�wawranu
M. B. plmer FUMml Home
1 M Main St Small Glens Fatla New YOM 12803 pww
And i Aimed Ey Me annual dirRlm as w,lreas WIb motion
mile hemp ramel a completed an"of the AMacmillan Form.
The peROn(6)IdeMi hem Islam Me Mrsonp)i n COniNI of dissembler,who W signing this Auawiadhow Farm,al as)
W Me acounry and amplabanaes a Me Informaeon annual Met In all Auamintl Farm end aurodays)aeWregong-
SIpMd pia 24 day a August 20
An aGnmddas
ti W eadco sl Cray Small Gleans Fa115, New York 12M3
Claire C. Karwpke
01802
ArdImM J.Grin i
srsw�r
O0S.1886-f(Row IMM) Page 3 03