Kercado, Joseph Fine View Cemetery $ Crematorium
Quaker Road
Queensbury, NY 12804
(510) 747-4477 or (510) 745-4476
FUNERAL HOME:
OATEB TIME ^PM�DU�,- - ' '�- -' - RETURN TIME
E REMAINS ARRIVED AT CREMATORY I.. �DP/
NAME OF FUNERAL DIRECTOR OR REGRIS'TEREO RESIDENT DELIVERING
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A ___ REMAINS-
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NAME. Tce�1l n/A ._._._ _...-
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TYPE OF CONT41NER '-�-'CASE p
_ .. �axM(Lty(UL LgsILfA" llgpQ � kC�rytLpyD PLACE OF DEATH,
ESTIMATED WEIGHT OF REMAINS M CONTAINER 1
PLACED IN HOLD: '"
PLACED IN REFRIGERATION
DATE OF CREMATION — ---_
71ME STARTED-
PLACED IN RETORT /I ) dfpn -TIMD _. Lpp"/d oi•I
/� _MOVEVED RETORT ry IN WXICry REMAINS WERE CREMATED
DETAILED REASON FOR DELAY IF REMAINS W ERE CREMATED
FROM TIME OF ACCEPTED DELIVERY' MORF THAN 4E HOURS
NOTE DIEPrION LOD SHALL o[ nE - -
x 1HE ppygxNLNT FILE OF Y"E CREMATORY.
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EWYORK Division of ^lul O0OPmA.1,,MM,,
OF
OPPoPTYNITY Cemeteries A'Amae�a
Terminal 151914bul
Authorintion for Cremation and Disposition
This AwhAnmmon Fields Mail ComplNed and signed ptloLmtlallwry of lamalns fwommal
Dab: 09-21-2020 NAAXr IQQ
Connotation Name PMeV Crtmemry
Audi 21 Quaker Read, 0u nenseury, NY 12804 pie, (518) 745417
CREMATION IS AN IRME R5IBLE AND FINAL PROCESS.
Cremation in human out by plaunp me rerama of the dB W add the eonmircr mining"n m kin I=a coal Member NTBie
they am smteclea to mknae hand add name. The heat and Imme well Inelnenm and aonsums everything except been and mein.
which am all Met will to NR after annual
Fouwnry aerrul Are vemmory As take reasmade anthem Rai re au men remains and othercremationrim mom the cremation
chamber but some minimal dust and residue McIlked,As left begird oThe maeamn air I eewam mhlnental and Fresh ma lFord
tle 9rdaire and He mticenbl and mrelpn naenal wit be demand M as will by As The Cremom remains von be MB SN®ly
Fulminate Into what pew and playdIMo a daslanamd mMemer or on Cremamd remains generally am PUI"i until an
single fragment s r6ngnmhle as skelwal Nssue.
OPENING OF THE CONTAINER
The hremi may only Man me container holding the immora ttd human deralm In limited dwmmanww autli aB 1omrMrm me
All M me narrowed or to ensure MN no macemrs eohmsm whAn might ones employees or damage the commonly Property. If
human remains an delmarad in a whMmer At Is not suitable filter cmmatlon such an Ceremonial Or rwi make«the
mnamn cone require Met Me inn ins be,moved Into a wltable somehow exam Kaceapb Me amalm. The opening O a
carbine,or TO In mush or remwel of remains ant He confused Mmre ahehaw add wllI de MnB In pnmecy, with dgeily am Mpect
OENTFCATM E DECEASED
Name of�wawd: denser,MBmado MCMV smme: lAl ((n2.hNi
Lot Knob Addrma BJEdn ReM, Sanb3n Springs, NY128'A
Player of Deem: BJ Estates Saialrga Springs.NYt2Y6
Eex: I7M OF Age: 81 Pros: �h - rao- a 9 Data of Death 09-19-20210 EBlirawd t '0
Dmnlpdw mwwxmwmem.w Mwe'ennmamewbedellOO:Jil S /'
Cartlboafd BoxX wNJootlen Base
PERSON IN CONTROL OF 99EWIVON
fa onfad Fr aa'rfnolmdmpoamon, �oNEama mwmmly
I anMb an MBd gnaMd Week of Me taw designated in a Ad or%ward instrument exesumd puauam m Pubis
Heats law Section 4201.
-OR-
A� IM1W haw no kmwwAltlet Me dewa5¢d exedmd awrMn instrument purnuanlm Public Health Law SeNon 0201 or a
vox w Miq mratlan tar the abaasmw of or r,er remains am Men an me Fuel hall phoney under Puhlm Health law
Small 4201 and nave Col tOm to wAdAme oem Mon of me moeirn of the decial *Mur rebuonaM p Ur to legal nm
sawn Joseph KefDado
)CS-18i(Poll. W2o) Pagel or
Authorization for Cremation and Disposition
(ian TmmmelebWow)
Number 3 O rlpbw Mara foundation(DaW9 O
1. Awrson design In wuing punuarit ro Public deed Law$BNM 4201(a)'.
2. The surviving spouse:
M. The surviving domestic paNer;
> Any survey;rig dead sepal yhaveof May 0r older;
a. Awarned parent
& A¢urvial si011ng eigntcen years M age ar clear
Is Alawfully epp li Modern;
T. Am protocol aignken years Of no Or dMr entroad M Wom in the nMM and wlrolslare dw St in MWaomnip W the exNeB1
S. A duly asserted fidutiary OF the aided
S. A dove inane or dome who why e"a awrMn sentiment pursuand to PWIC Heats law 5ecom 4201(TI:
10, A Uolocaal Rather M a muter Or a WMlc administrator assumed pursuant W Led Sumordo s Court Fiscal Aa;
four My r Parson who a acting onLenalf ON tM decomme and who has ex¢ylee a wren statement pureWnl b Pudk l M
Lew saeion 4201II
(r(r� �(a o�/o�yf ALL THREE of Me blowing)
_/'+�_Wh tarehy affirm Met tic EOSy of the dereasad does not contain a behary, battery pa& power mLL normal Imel
or nat raalux device and Mat any such malerure were removed prior W the execur once AnMon'¢s0'M Form. FRIIOia W mmoae
t eau Name polar W wemWM may teat In M m W to Ommabry and mmabry Iaemo mi
AOL W affin MatimtmdiamhewbeangivenW RoanG Hong
re AM,vq the removal of any cersOml pm Or oter Ming ofvaluewMM am lemon mgnng blow Martianiry marrosel
deceased wishes W Formal Pone Nwa Creommy
;snot rtspmt101e for led remwel Of Poreonal tame from Ra common or ham tM decade oftic gene d Paraanal Items hX In Me
co Inerwwtb Manmalnewillbedaevoyeeby Macmmaonpmw andtannWbemMewdabrmmatiae.
M Mnby 2u Gh FireewnCmmmay
nwasui
W mmffi Me steins of Me clema d.
(Initial OPTIONAL)
Wx hanby auNorlae Me named Wnml tlimcWr to povde for delNary W and cremWlon by an alAmaW
atary,It daemon nxneary In Me opinion W Me fumial dancers,and to amen MlJorm to provide"comet name and
address of such awmam cmmemry.
FINAL DISPO IMN
The person aumon N to remiva the Camabd remaiM a Im tlilWeaW been Bear mm IS
Name. Compassionate Funeral Care
press; 402 Mi Am.. 59 aSpurge ON 128M p�. (Still SG<544
TM chairman manatm IN bemamd sell be du¢sMd Of p MF R S.
`�Z ,k a. I �, C , L ��
If far any Oman fie pawn named Yw 2 nWtale po.¢meioncede aamlalad mmsin.
Rre Wx Crenni a automated W gWa sssmbn 0
lie demand Cmpeuvneb Fum Cm. line by delivery
on pares Or by mg¢ mal Josh"rm2o
;cocoa
Dml1 f(Rev. 04120) Page 2 of
Authorization for Cremation and Disposition
! Ire rwmaarim
INA understand that it Na rtmeM¢are not GalmM vnNM 120 Eep of f,y,mhai.
Paw Yww monetary
✓cent May dlepxS Mtlp eastern In
arimwnaa manner. :eery Mewtlenng. r
4REMONE i s COMcapari ORN
(t(�MGNE Nine ldbvvpf
M um M W used as conaMer for the aemaded summary has and purC San
ands tlawCW was bond'.
If understand WI it the um is be=811to Md pa seem wemM remains,en additional rigid container may the used for delrvery.
M um I¢r�yin Wrpie¢N. IMb under¢rard tin HMUm i¢Wrdtaw wotl mise pmlded
PIre view Cm me will pace the wemated remalnan
a rand machinery consumer for dNM1ery rvsneawrw
The Amindivi Form Ma prowMe]W Roland G. Hop was exeurttda
�Jywki
Cwnpeuiomose Funmal Care. Inc
402 Merle Am. faagge Epmg¢ NY 12W
and a¢anW the weral dllecter as sionea to In emwaon. n
may,Ian reared a completed shey of this Agronomist Form.
The "memo) IdentlflM aelow lelam the morn ie)In wntnl W dapallon,who by signing Nb Aubwtrabn Form,mpagv)
to this accuracy and win plMees W the I eformvtlon canbinW In this Autlrodm n Form and suroundig)one foepoing.
Sign"this 21a1 day of Sepemndr .20 �0
Deara Hwm]aRlvers
RdaN G.
t18N v
u sseph lrnmW
DOS10W(R MO) Page 343