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Keller, Martin B. Fine View Cemetery $ Crernatori,en Quaker Road Queensburyl NY 12804 (518) 745-4477 or (518) 745-4476 FUNERAL HOME: DATE 8 TIME RE RETURN TAME MF"NS ARRIVED AT CREMATORY: / NAME OF FUNERAL OIq ECTOR OR REC RISTERED RESIDENT OELIVERINO REMAINS NAME: - - ... .. mbRxsu _�F,(FF2 1p�-- TYPE OF CONTAINER:. 6._{ .CASE # fl MPoc nr r- . _ g�w,/ .nrldY6� PLACE OF DEATH: (U fYt M.1 / . . -_ t20 fAI _r„Sl1 ESTIMATEO WEIGHT OF REMAINS & CONTq IN ER PLACED IN HOLO: PLACED IN REFRIGERATION: DATE OF CREMATION TIME STARTED: -- 10 ?P ) TIME CF,MpLEyOER PLACED IN RE TO RT pN Z I��O r ' 1 MOVED L.I - RETORT # IN WHICH REMAIN$ WERE CREMATED: __ _ JiSEPnI_ ZII''i_Drn DETAILED REASON FOR DELAY IF REMAINS WE1tE CREMgT S l FROM TIME OF ACCEPTED DELIVERY EO MORE THAN 48 HOURS FJOHLITECREMAyl,00 ___ SHALL o[ nci vk nD _V.:pxkrvTFILE Oi TVF CnenniORY. Now sure SEW PORN TryK Division Of 1>re.�wnwsw - STATE�NE DARSMN OFEMUTE Cemeteries Clusters,....olnew,�w� Takeartovers Federa 2[ Authorization for Cremation and Disposition THIS Au d"dan Foam must be ccmple dantl Signed pool to"Mary of remains far cmmatlon. Date: 0 Names: IdIY crem.tay a /IP / mate¢. me�4 -ebuil Phone: S/k - 7 fl — V V y ? CREMATION R AN IRREVERSIBLE AND Fli PROCESS. Crenri is cabled out by Pacing the remains of Ne oeceaaed and the xnminer Xcklap Me mai lm Into a cnmatlOn dramner"am May or, subjected Wool neat and flame. The heat and llama will lnnlnerete and c,naume wrylNng wept bone and metal, which am all Got will be left~aemMion. FollOwlnB cherman.the mmalory MII Wks reawnaee effoM15 b remove all of the remoras and other malmkl lmm tie ore motion chamber.but name minimal dust and residue fall likely to left bMlnd. The crematory sell improved lncidenMl and remain material from Me remaim¢and the Incieental and Main material fall be aBry¢ed of as required by law. The aemattd normenl:All be mecmmmily pulverized into sell platen and placed into a tle&gnaked wnWner Or urn. CremMed remains generally am puMdzul We nor Al fragment is recognlmMo as ske Ul tissue. OPENING OF THE CONTAINER The crematory may only open Me container hadine Meun war atw human min am¢m limited cmunw anw¢.such as to confirm tlq identity OF eecee¢ee or m amore that no manNl ie m ni whim might injure ampleyaae or damal the pemeary pareaM. H he rental are dtivaW m Sweet cents Inv.r M lm u mMbl I. noe far anmn ma al n as afirmo l of mMl cookie me commorymwin require Pet%a remains be moved Il a suitable container mMm itaccepts Me remains. The opening Ma nsumer or the transfer w removal of remain¢will be condoms] bemre a wltraan and will be done in privacy.fats eignM and remect. IDENTIFICATION OFF DECFAS/END ryes V l Name of Oecm¢ee:la tnJrl ✓t B. kidde✓ ma ismws IIWI Last Known Adores: to L r r-/s ls Places of Deaf: Jn 4. 44 ,i , S'ff clS liYg a1=iaA �d OIL- Sea ©M OF Agar DDR: (it I tfo Dam of CeeM: 9/0 /1A EadlmaMd wstaM: 700 Doan tan Of¢awtKonleme�/' w��nlCh remai 'll beaelifered /Y�Z;rA y NLIL �f7SE ""'ovbow -6Ait O Y' PERSON IN CONTROL OF DISPWMN J mnow"In canbdddepaWbry merafONEolW h9owNg) I aml are the desgnaiM agent Or me tleme¢M designated N e MII awdnen Instrument executed pumumt to Putho HnM bw Secion 4201. �OR- ever gdrM1avenoethed knowledge Mm the eereahetleveWetlso "a rre¢Wmerspmwaveng Pudic Health Lew Everett Law contalmng noonestlet Me toov¢Mme his mhm remains eMs of are pr[rnly under M e H otaw Section 4201 and hate the Xgnt maumoXie uematbn of the temalns elms decsased. MyN)m nlsYonsFlp He Me MceNetl is follow¢'. YY DO -groat lRe¢hil page t of Authorization for Cremation and Disposition pnaallmmma xslceawl C -- Numda '� Deecngson. . Jun 1. A Person desagnaled 'in wdgrre pursuant to Pldlc Heahh law5ection 4201(5) 2. The surviving spouse; 2a. The sue lug course,put ]. My surviving child secure ram of ape or do&, l Reurviving parent 5. A surviving sidling amour, years of age or older: C A Irvsully appointed guaMlen; ]. My pwsonpl eigMwn years of age Or deals an00ed M snare In the estate and who share dnsut in Metionship b the dawaetl; a. Aduly kernel fidl of the eA ; p. A dose crop or mai who has uewbd awn0en statement pruant A Public Health taw Season 0201 ge 10, A that limes l eN rot a Dole"a when administabr appointed M,sent to Me Suncyp's Gus Proyal Act 10a. My dnesPerson arms ading on behalf ofMe dx"sk and who has executed a weapon WtweM Pursuant W Public Hei Law section 4201 (I(yyfll-�QIIlALLL/_L THREE elide Isfirmf s ` MIL IIWe heresy affirm that Me MAY of the deceased does and order a hallery,battery pack. Fewer are.nderec0ve imdal a rdroner Mauler and that any such materals were removed prior b the execution el IhIS AUM RUM Form. FellunWreemove lthu�js�Xoe'm' s filar to cremation may revolt In harm bib cmmNU and Wct personnel. 11/wa wmn that mauumona nave Mean given to —�nn e S liki at regardera ire mntowal of any p wleonalole7 or clnt �lr/g dvalue wa ni n sts baWw«any fam aft he member e deceased wlanea to Mae". ' center M y 11 Wnl�V AM0.�-DYi rat rvl is not responsible ba0k Nmoadol personal Ilemafrom Me rehearsal the remains of Me decased. Personal Hems Mfl In the container or with the renena wlnslr�edry the nneffonmoc*/A nd cannot be nbeved al mmal j � Ilweherwyamh,flu ✓1 < Vi I W ( "were"Ye bcr nMe Me motell ofthe desaaaed. ArNSIOPT1ONAy V Mr,hereby aNM1nde this /ur namedxrtl pursue b pr far r detWe b and cma0en by an dbmate aM ear . V de me mu ne ibry.in e spin Is of the fumanl dlracror, and to amend Mae bmt to provide lb connect moms Add after FINAL DISPOSITION niece mthosTdmrer.Iveuecr a.mmem;of the de food from do eventual' Na s l la 1 9e m T c Miami Yna;� 5}„e•..��-;-Ik�ak Phdn.: Sle- �u�— u.z�z The=maappq pp aaewaeedoinbd»goeMm"4' IlE�f I<P fiat r r� c� � r motions amed.bmid nmur gosuulm au.mmwd revere, ne. V 1PW pL.Y..s MID r ' to auMcdaed to Me summuslcnOf Me�ins aj 5 ma. is by save. in re�a dy replwlM map. wa Am klp /le✓ pw,avwl Dos-lbgea(Ray. RAM) P"2d0 Authorization for Cremation and Disposition pg/fy -- mine unp unEmelMMerenains noltlelmae xiMln tYO tlendvemalkn. V/ nt Vi?w fhvv�tl ' merai¢p¢.e cl lna mmawm an imNevepb manner, such as 4 amusing, CREMAMN CONTNNERNRN g iddr ONEof OeyMwmse) An um to the used as a consumer Add the mmNM remains has Man WmssYp from and aMsalMp as Idlmn' Me uMemWw that it this um is coo was to Ma Aa enure oema tunaire.an addNonal Mid mmaNer mry be warp fn delivery. //((��, \\o�s-p �� a Ili AnumendyerWmh p auMere4I/nf Nalsne u7m purchased or MMrx%e prodi l Ptre Vlew Crememrlum P �' 7P (� ( /^rp/f1Q O r(aEiAll prow We mmatep nmain¢in a rigid temWrer,container for MNany, This A orientation Form Me provyep Er +' d�PPO'a `� � �.srot "a uxumd at / n (p Ain S' rffivivef �...n.., c�vn �!!<� /tS dead I. signed by the funeral director an vide rs min execution. INIe have reserved]a complabd ropy d his demonstrated Form. The diamonds)Internet Mlw Were Me prearm) in Rental N dispoalNon.who W signing this Aumwdand"Fumy as s) mp the - ry acccura and I mpllaapntam in as of Information omant In�thiisss AAuuMOAaallon Farm and auMMnp)IM!cohering. 00 III .20 �J� mi Rai MUvYlPti7_S • All 90111,11 1n OOs.18984(Rev.nano) PM*3d3