Meader Jr., Jerome C. Pine View Cemetery g Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
rUNERALHOME: - PAPSW _ nlQ('p.lft RETURNTIME:
DATE B TIME REMAINS ARRIVED AT CREMATORY:
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT —
DELIVERING REMAINS'
NAME �—
_ - �
TYPE OF CONTAINER F _ /** 4"-
PLACE OF DEATH: _..YMl9I�I OWX
�„_ Ity1T
ESTIMATED WEIGHT OF REMAINS 8 CONTAINER,__ _'CDO� /ZMz II
PLACED IN NOLO:
PIgCEO IN REFRIGERATION; --
DATE OF CREMATION:
TIME STARTED: . TIMECOMPLETED:
PLACED IN RETORT; S:jCJT_q _MOVED:
RETORTfl IN WHICH REMAINS WERE CREMgTEO: __,
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN qQ HOURS / Y
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION O $
nLLOEnE eLRE PERMANENT flu OF THE tn¢mgTEpV
ent of Su tiff
Department
NTO ORK DivisionOf °FASpa N.M p�
°P"D M1W. Cemeteries D ,sr w
Tel.aauM..,ste.NaBaa
maW
Authorization for Cremation and Disposition
This AaM aN Enron manor cmnp and signed pHm M dnlvery W remains for m�mlanon.
Dab AUGUST 29,2(120 Nunmr' 2020U29
Cmmn I Name: PINE VIEW CREMATORIUM
Amy. QUAKER RGAD OUEENSOUM, NY I2BM Prove. MILT45N77
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremation ie will Out M among May warmwallof the mce and Owwmaaoe irq M me remains into a aemaaon mammy re
May are haddete.1 0Intense Mat and fame The The Mrt add fhm¢will lmiw W and cmmum eaarythint aacePt b aM nwW,
oTkh are all Met WII M bR agar ce UOn.
Following cremetiM,tlIB mora ry wall take Reviews,efforts to narrow all INt1b remains and other mneral from me amaged
cna roar bN VYne mill dug and reakue kill likely M left brand TM1B ONnatory vAll ee(ureN lncgenbl end loreagn melBriel hart
the ra+ans and tM an,i,kribleM breagn ma@nail will Ce tliaposB]of a¢requi Nhy lax. Theorem mMalnsxdlbem, iMl
palrenred Into small shwa and ahead into a demanded wnUirer Or urn. Cnmabd mmalM panerally am pulaeX all no
single fragment as recglnlnbb w SW MI Vague.
OPENING OF THE CONTAINER
The ahmetory may only even Me container holding Me uncremaMy human remains In limited rircunaMmxs, all aB to confirm The
aden4tyof the des 1 or to ensure the no material is hncloeW whiell might niud employees or daunts My Mm=m goyeal N
human contain an Gliwred in a door which is cot autMbk for cm Won gush as�lal or Meal u Mt Ma
coal will repalne Met the remains My mown MM a sumwe Cord before Sacw may mmnng. The goal aH
mmaaner or the danger or removal of remarrus"I[W cocanduchel Iemre a adding Wit ad m eons In mwq,with vitrify and rdy%wO
DENT F CATION OF DECEASED
Name of ceCeased: JEROME C. MEADER,JR. Mums SeWc MARRIED
lastKrcnn PGdrew; 14 SAND BEACH!MY BWT W .NY 1315
Plash of Death'. 16 wo BEACH NMY& LANE.MY IM15
Sa,.. Elm OF Aga' 92 me 04/24/1928 Dole oD OMM7020 EMMM Weight 200
Dewlpmh of o.k W aam,w,n wi amaeine teem dnwmm.
FLORENCE CASKET COMPANY/CREMATION CONTAINER/CARBOARD/FIBERBOARD
P °
(P (8)In a new oidspuilion. mow ONE Or me M.haMgJ
I aMlM1b lie the rka9nnal agent W memuwM dwigre in a My or argon kmB t aeulM Pirelli to Pull
HeMM law Secret @01.
OR-
ff� WJe have no knwJ Otml Me mossaW Executed a whoortmou rent pursuant to Public Health Law Satian 4201 or
wall ethanol dayearkers M ale dbpWam of his or Mr remains and IMre are the pool handing pnonty under Pu mks Health Law
Section 4201 and core may right to euVadBe MemWon of The remabre of the mmashd mosew m"omhip to tin mceag Mae
fol a x
JEROME C. MEADER, JR.
Ol al(fore.WOOL Page 1 o1 B
Authorization for Cremation and Disposition
fbeirt hne the ear bead)
Number 2 �empbm: SPOUSE'Verm
1. Anerson designated in mono punuart to Publie,HaNN IM SeCai Man(3).
2 The surNwnB apcum.
as. The invest;EmneYlc Carter
S. My vnvlNn9 case M9nleen years of site Of(Mker
<, Asuriiviig fared:
5. A sunnng sinner egnl¢en years N are or Mtler.
6. A lawNlly a(polnMb thermal
T. Any Pattern) signal Ram OF age of Neer er WTo Mere in The e9ab and wM NJUP dayeat In rWa Mhip of Netl SO
6. A duly appalled fiEWery d Me for
S. ACode third or hall lve add has colienM a widen eblemem Wrdant to Pul HWIn tax Sudden 0XI(7),
10. A chaff fierBl officer of a Candice a pudic wiminlMretw aPoolnt¢E Wrmant b he Sunrynb's CM n PrOtttlure Act;
10a. Any ones pwvm wM IS brand an beRlf of the deceased and wM nee ee d a wrilren aratemmt pursuant To Public Hearse
Low Semen aol(7).
/ (()i gtyALL THREE Of Me MWatny
4p2�` tie hereby alone Nn Me bul of to eemamtl tlma res Wdae a talent, nerdy pred poser Coll. raoadese lmpbanL
or 20bparlive tlenm antl Nelany 6udl maMrvalswme rdnou2tl pnw10 N¢¢xe000n M VISAWnMtlan Fanrl. FMlum W R ws
Neei1xM Prior W cmbm mry mW N Mmi To lot Monetary and Mandatory p n".
fNNa aMrm tlW lnatru]'nna M1eve nee Bbusn to JAMES P. MCDERMOTT
M;MNne tie runond W any personal propCRy,or c r dw of valna whi arty perem atldre nekw«any bmlym wa Me
dec¢as msresbpmwwe PINE VIEW WIEM4TORIUM
u mlMrynaiM¢krtne removal of Porwntl ileee hdntM rvntaeer Nrfrom Ne mmaea0l Me deceamd. PommilMmS lnNe
/ whinern do mai or wHmnawill assassinated bra m Cente pro m sent and cannot No nreved after Nremauon.
✓/ tGs WJelwebyaullmnm PINE NEW CREMATORIUM
ro"an'r`° mMMnla tln remain der.daeeaeaa.
rhmat oanOHAL)
Inn hereby auaonss Me nand Meant director to tender for Cornea b and ce on ray an aamaM
Glory,d dear mad necessary in Me og mon M ote funeral din ,,and to amend aid lean b Missiles they w tOaee and
address of Bush alamab cre tot.
FINAL DISPOSITION
The Pusan eNMia¢d brembe Me Ma Fe MRftla deYMd hue Me Pmnelmy Ire
Name; JAMES P. M DERM07 OR EMPLOYEE
Address 9 PINE ST. OHESTERTOWN,NY 12817 pfxswrnwu51668A2311
The Vm Wreads W dxaved WN be oispmsd M nM
it for any health Me peon neeN azrne delta not Iarks,wBsnvn Mote vnnaMd n M.
PINE VIEW CREMATORIUM a eMMreM 10 give professor of
mAL
Me remaiMfd BARTONIACOERMOTTLUNERAL HOMEINC tydtlivery
in Pattern uEy regyebrM mYl. JEROME C.MERCER JR.
p.saasl
Ccreflu I(Raw NOM Pep 2M3
Authorization for Cremation and Disposition
/fIInAal ma tdwwpl
HWe unaereUne Met it the patens am isedwaRC want 1306rysNoemB4ati
PINE MEW CREMATORWM mry NeWsoltls�wntins In
an l Felanble manner, sun ashy uatlemp.
CRENATIONCOMAINERAURN
llnNa ONE dllie Mlgrvny
M um to Gv uW as a Container Sir VA cramand mmw M6 ban paCaaed kern
BM ieMWibeEUMlw.a'.
/NE[WR uMGeEInO Hal it Me um is Eso"I b hold"have canniness nntia,ii madamial rvpd oMbisar mry NO MIND([W densiI
✓ JyNL`Mum ieMYtt WRdNead. IMle ubeaa�q tlwlHm wn6WNatM wOde+atee aonded
PINE MEW CREIMTORIUM still paw me Mma ma remaire In
e n0id tempanry eonamerboeHvery. m..ao.r.mn
Tnu AUH:orizetlm Fan va¢pmvgatl pt DAMES P.N9ERN017 sees executed al
o+ vase
BPRTOWM DERMOTT FUNERAL NONE,INC.
e%NE ST.LI£.FIERTOYM,NY 1]81] ���
and ishVelny ne Nneral tirecmr a a vAma¢¢to In axeoNm
Me have rtCarved a composed mpy of this AUNertratlon FIXm.
The miss l ldanaed blm aaretla penan(s) 1nsoMol of dYpoapbn,Wu W WNrq His AUNwlallon Fwm.&Ngs)
b Hu accuracy aM canpMlwreas It Inbmutlon[ddalnad In tlYS Auerorbalbn Farm and aindessami Shia finepoing.
Signedmis 28TN yy a AUGUST di
ELNAA. MEAGER
Nw
POtlBOX a BFANI IiW.E. NY 12515
WRNESS:
DAMES P. MCOERMOTT
12330umrw>m.vw.w
a JERONEC. Nina[ 0.Jk
sa..s w"i
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