Garrand, Michael E. Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(sta) 745-4477 or (510) 745-0476
FUNERAL HOME:
DATE S TIME REM -'-' RETURN TIME:
AINS ARRIVED AT CRfMATOflY:
NAME OF rUNERAL DIRECTOR OR Be GRISIECREO RESIDENT DELIVERING p
._
REMAINS.
NAME "----
NirdIAH, FeRRADD ___--
TYPE OF CONTAINER --CASEa
PLACE OF DEATH: `b N� _. .t�aft
_. * _ Z ,,._ /, JA _..__..
ESTIMATED WEIGHT OF REMAINS M CONTAINER
11
PLACED IN HOLD:
PLACED IN REFR14ERATION: - �--.
DATE OF CREMATION _
TIME STARTED: � — �(
. kh _-TIME CO I}ry PLACED IN RETORT
MOVED:
RETORT D IN WHICH REMAINS WERE CREMATED;
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED
FROM TIME OF ACCEPTED DELIVERY; MORE THAN AD HOURS
NOTE; HIC CReMATION LOG SHALL BE RETA:NEOR T HE nEXlnpx[xT FRE OF THE [XEaniopv,
Sanders
OaPorMml alkState
NEWVONK Division of DIVISION OF CEMETERIIES
SrATEOF O C R
OPPORTYNnY. Cemeteries 99m YrNyun Avenue
23Want
ieepMnet51N0661]6
Authorization for Cremation and Disposition
This Aumon':amn Form meet W completed and signed prior to del nry OI remains bar attenuation.
Dale: 09212020 Number i�y3
Cmmffiry Name; pine Vim Crematory
Address. 21 Quaker Rd., Queensbury NY 1280L Phan. ?ICVNQ
CREIKTION IS AN NiRE MISLE AND FINAL PROCESS.
Cremation is owned out by during the remains of the demaaed ale the Container Mlding the remains 'into 8 cremallm cM rWSara
they are sugede to intense heel and flame. They nest and flame will netnews and comume everything except bone and metal.
which are all mat will be left after cremation.
Following vema num the GemalOry will take reasonable efforts to reprove all of the remains and other materiel from Pe model
UemRv,but some minimal dust and residue will likely be left behind. Tne aemmary will separate Incidenml ale foreign mentioned hard
tMremainsandtheinudentalandbregnmatenalwillWdiyw MMrryulredbylaw. Thecrematedremainswillbermc ly
Wlvenmdlnto small pieces add placed Into a designated mnminer or um. Cn Wmmaimgemrallyampulven un0im
single fragment is nccgnina as skeletal Spars
OPENING OF THE CONTAINER
The thematory may only open Me mrdimer nobmg the urvumrated hunan remain$ in termed ciwnabnme,area es b confirm the
'✓entity of the demanded a N ensure that no material is encbsed whim might injure empbyeee or damage Me cRmelory pmpem. 9
human remadn$am deliverW In a container whim m net soimae for remember auan as comm ntaI or rental take pat,Me
maniel win deal M m at Me mairm gwea be n Into a fulmble aenlainer Were It accepts Me Rename. drive opening of a
ember or the transfer a remwm of remains wall We conducted before a stand and win be done in prlvary, win artery and respea.
IDENTIFICATION OF DECEASED
Name of neceaaea: Michael E. Garrend mamal stews. VJtdOwed
Lads Known Address: 5699 State Route 28N, Na mb. NY 12852
Place of Death Deceaeetl's Residence, 5699 Stata ROOta 28N, Newcomb. NY 12862
sex. ® M OF Age: 72 DOB: 052811948 Data of Deets: OWIM020 Emmatedwelgm: 175
Deam peon W caMdVm z mat In whits renvins Mi be delivered.
New England Cremation-Deluxe container
CONTROL OF OISPOSI
(Ferson(al in deal W dbPoaffear Infest ONE u`tlre Refusing)
I warned are the designated agent of the demanded designated In of ll or whiten instrument examined punuan110 Pull
Heats Law Seal 4201.
-0R-
ldc�Plffle have no knowledge that the removal sweet a semen inelrvmed pursuanlb Public Main Low Section 4201 or a
AN mMainiig dlretliom for the d6pasition of his or had nmelne and Ilwe are Me persona$)having prorty under PuWIC Halm Law
SCCign 4201 and have the right to authorize cremation of Me remains of the demanded MyMur mWiamhlp W Ma decaued M as
follows'.
Michael E. Galrend
DOS-18984(Rev. 04R0) Page 1 03
Authorization for Cremation and Disposition
(Imam fmm the line beaw)
Number Descnp9oa:Survvna Child
1. Aperson Cesgna dIn where pursuant to Pi Haven Law Section 4201(3)
2. The suMvirq spouse
U. The stral removal saner,
3. My sureving c rim Hgnden "am of age or oast,
0. Asurel paten,
5. A surviving sibling eighteen years M age or older,
6. A lewlully e(peread downturn
L Any persons)eighlean yeah of age or older amend to more In me estate and who loom deal In committed to Me methanol
B. A duly
nted fichundary 0 the
9. A coup frienda role wM has executed
bse friendie a wren removal moment to Public Heats Law Secmn 0201(T11
one
u al
rator
por
1e. Ayothercelson adviser who
a wunlg or a behalf of
the command
gpi who has avers Ne Sutran st§Coun PrarAure Pop
10e. Any Olnerpereanwno is sane on bmanonnerKK9asea and who has a:ecumtlawrinBn anremem punuemmvubur Heats
Law sem'om azogn.
gr gi T AU THREE mi hadors4g)
1 Fmyse hereby affirm that the body Mae dewased does not contain a baMry, baftery tack Powncell, radioeNve Implant.
movement deal and that are such more s were removed prior lathe execution Minis ANForizatl Form. Fsltunmr Ove
Memo items Oar m marratlon may result In Nmrm Me crematory antl thermal Personnel.
h/`7Nwe affirm Mat membrlane have been given m David Alexander
regarding Me removal of any removal radial or toner Mire of were which any screw al below d any family member of the
ceased vneres mprcmrve. Pine View Crematory
1e not reepweible for the removal of pereonal items teen Me container or tram the remains of the aerosol PMored bnin left In the
container or vi the remains will WMressed by the Cremation WN and consup tea removed after anneal
M hereby aumoma Pine View Crematory
«mmwrvum to Cmmate Me remains mains deaeaeed.
(in"OPTIONAL)
It happy supported Me named funeral db«t«to pmmde for delivery m and aremagon by an alternate
amatl ifaesmed monetary in Me opinion of the Nneral dlrwmrt and to emend this forms to stouts Me Poorest name and
address of Such alpmeN Charms .
FM DISPOSITION
The Poosdn outlander to receive Me operated remains ofthe discovered from the vcmmy is'.
Name:Alexander-Bakal Funeral Home, David Alexander
Agenda, 3809 Main Stand. Warrensburg, NY 1280 Pone: (518) 623-2085
Ta creirekd remains of alcohol still be dlspmed M as fillers
Rehm to family
It or my resvon the person named above does all Wee mora M M the operated remains,
Piste View Crematory pwammdmgiro po9umiwM
Der mr ns to Alexander-Baker Funeral Home by delivery
drearembi
In person or by registered mall. Michael E. Garrand
vm�nao.tm
DO Ideal(any 01 Page 2 at
Authorization for Cremation and Disposition
(I has dowayarl
uwe understand but Ifthe remains are net claimed aiMa 120 days of cremation.
Pine View Crematory may dermal of realm
w..mo..i
an iteaavable manner,such as by scattering.
CREMMN COMNNEWNRN
draga ONE of the remained
Alexander-Baker Funeral
M um to M used as a consumer M has cremated rcmalM has been Purchased M1wn u.....e
and is Modified as burns:
Imas undersUnd and If the um 're too small to held the antlre mantis nal an additional Had mMeirret may W mom M d4neary.
--CF?-
(!1c(, Mum is nM yet Wrchased. MouMmrs dMMdnoum la Wultaalloroemsepmg
Pine Vlew Crematory fill plan the cremaad remove in
r..muo..wa
a dill temporary renminerar signs .
This Audmdzegoa Form wa prooded by David Alexander wa diamond at
Alexander-Baker Funeral Hone
3809 Main Street Warrensburg NV 12N5
and hissued by the funeral dlrxM as areas to es aecution p
Me have recervM a completed eopy of this Auflrwlzefan Farm.
The mnonis)assured below lelan the panoMs)In control of disposition,who by turning this Authorized"Form, amended
W the accuracy and completeness of the information conalrutl In Mie AUMo@ellon Fo rn and auMOHzya)the refusing.
eremd Vale 21st day,of September 20 2'0g
Michelle G. Bureau
W�
6R aw0otl Hollow Rd GueensWry, NV 12806
m.esarwe^.,. seer..
AI
WITNESS: D
David Alexander
1oo3eI
Michael E. GarraM
Irr�rwo.�w
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