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Farmer, Howard L. Pine View Cemetery & Crematorium Quaker Road Queensbury, NV 12804 (518) 745-4477 or (518) 745-4476 FUNERALHOME: B14q nFOM/�i '- - --_.... _. RETURN TIME: DATE 8 TIME REMAINS ARRIVED AT CREMATORY: 1 NAME OF FUNERAL DIRECTOR OR REVRISTERE REM RESIDENT DELIVERING�T 1: _ V.ly... h40vngt mA1Ns: NAME: _. - Hwgnp PAgMEP -._ ---_.—_ TYPE OF r( ( CASE ryja . CONTAINER IM4 fo '* / yam{ r PLACE OF DEATH: L4•I ESTIMATED WEIGH OF REMAINS 6 CONTAINER (n� T 11 PLACED IN HOLD: '� �P _ 21o4' ir PLACED IN REFRIGERATION - -- -- - __GATE OF CREMATION, zor ��— --- TIME STARTED. _ 5�--., — - ��TL(tO,_. me COMPLETED. qry PLACED IN RETORT "---L- ' 1 MM _MOVED QtO RETORT 11 IN WHICH REMAINS WERE CREMATED: DETAILED REASON FOR DELAY IF REMAINS W ORe CREMATEO MORE FROM TIME Or ACCEPTED DELIVERY: AN AB NOUR$ NOTE� T"e �RYMRTWN LED SHALT ^E ^e x me PemmAxkxT a LE or rut [nemnlo^v, VOPPEW YORK Division of prvlslox aF wrasTanFs Or ORIUNIiy. Cemeteries elhInall NY ,overa Authorizatlon for Cremation and Disposition Thais AUMaNmtlon Fah made Ee comp and Wp Puler to demall of rmnelna br u MIM. SEPTEMBER 19,]ORO HumEv. 2MW32 Deal �035 IXanUwy Name',PINE VIEW CRFJMTORIUM ��. QUAKER ROAD OUEENSSURV, NY 1380f Phme: 5167A6A47 LPEMp1gN IS AN IRREVBR30 AND FINAL PRIX:EBB. CrtmAOn is barred out by abodug me remains of Me mNwd J end For mrnanm holding M¢ranaireman a dwwyon tlaanary were shay are wbj¢geG To amounts M1¢et and dame. The Mel and MmB will mciwmdm and WMUMO aW IN easpl0mn and mml, w h are all WI wNIM Ind MW ammwm Following namalian.Vol consumers will Oka reasonable edMs to remote all of the remains and other mammal man Me MM Mn door ON UXnB mammal dust and maybe xlll Way bB Ind MNlnd. TM1e aemalory rill semrela mcid uncle and forage meknal ham NerBmeinsand Ne lntitlrmsand dfweipnm amnagamed disposed of ae ueauired Ey law. Tao gemaNy remainswA long no single fyimou d pa ns So s onion yatigrum]cLYamare'murn. Crernabll lMnalm panernlly are Wlwy[etl urNl no single IraOmMb rewpninW 88 akemW MoueOPENING OF THE CONITAINEIR The eRmetorry may only Open me common holding the unSRme human remains in limited GFm OsmmA um s, such as to TM1e k tty are W ssedoto encore that no matese IS asMwM1lCn migMmlure employees orMmegetMcmal PFmmwy. It humanremairu am dellveretl In a consumer which is her suitable for cremation such as c menial Or moral ca mdw owners,will require ands der mmaiM M mwvd Ints a Bu1marecomysiner Mlore N accepmtlw nmmind The op IN Of moralher or 1M transfer orremava W remeire all he conducted eel a w tV and Yell M domem pywry,wiah dull end ram. DIFINITIFICA311041 OF DECIESONED Name 0Decreased, HOWARD L FARMER Miami vV.1DOWED tart Known Oddmu'.B O1M51£P/ILLE RD POTTERSVILLE,NY 12W Plereol CeM 1111111 ; Sex: ©M OF Agar DDe 07/2711825 DmedoeaM:OenanOxo EeOmaW V&Ott 160 Demimonde or cawaumnMaw N wnlua acnan.ads W dalYmed FLORENCE CASKET COMPANY/CREMATION CONTAINER/ CARSOARDIRSERBOARD 9 x fAMRot OFDaPOM11M fPorsm(a) " ttnbN Mdspo50.M. ILappa ONE Or we fdlw w I emwer are NB designated®ant a The MmmM to greled in a wA awhMn Instrument MeoMd Pureuad W Pudic Hearth W/BTLon 4201. -OR- Zrwr WAY Mee no Mmeg Met myr OaSBBM axxNed a Yemen lmdmmmd payment b Padat Health mew SetllM 4201 Ofa vall mnmining dKcrons for ee depoAmn or has«ta roman and Ind are 1M Ferson(q hand pr(oddy under famic HeBM TINY Sttlim4201 and harm Me Not to anhorm demand of Pe wholm Wale alma Wy ur mlNoreNp No 1M Wcwaed Is as blow HOWARD L. FARMER DOS-1R f(Rer. W201 Pagel 03 AMthoriiaion for Cremation and Disposition nfaeNmam melletdnM) Narrow, 3 Ma6GNaan: SONICXILN 1. A parei d6igwtea In wri president to Pu Mo heats the Samoan 4101(31 L The paravng spfaw, y. The wmmng domestic fad0er, 3. My worm omW aghmen years of age ar dome', 0. Asurviving parent S. Awrr ing Imirg aghleen Years of age W doer', S. AMwlull Psmanted guar&an', >. My perwnnyfughtmn years at Mile or older limmad ro ara+e in me etlate eM MN Were daeY In relatonshlp O the demaead, S. A duly ap[gMM fiduuary d has dale, & A date plead or relative alto has meMW awMln statement PaauaM m Pube;Heeds law 3addar 4301(7)', 10. Atltref fi l Miami of a Cmm)? or a padmadmloistrdor appointed punuam to Me 5urgaale'e CAN PrcWdum Atli 1M. Nry ocher perm v.M is Aong on Metal(of the memeasao$no who has we a andain abbmeM puni to Pill Health Iax Sella 42M(7) /,(T�y�@,.ALLGMREE of th ldlowiny ✓ y.. EL zMre elflrm Met Me many d Ca demamatlres not mnWr.a Geoety. Mary N?.pcav fall rafoalre lmMI w r odo%We devim add M9 am soon immune score reman a Mort Me ereortion d has RMMNatlerl Pepe. IdiW m Me /th®eM<pmoras cremation may Month in Krm m the clerrulwy ant crwnalay peserrol. / �W4 pNg Mann MaLmMutllans ham May given m 'l4MES P.McOERMOTT ✓✓ mystery;they ray l of troy prtorel Model or ahermi of a spot Me Geswn agalrg mi wane Mmiy trends ad op 4msaM vnslmmpreron'a. PINE VIEW CREMATORIUM ie tits reSlmnsialeftt Me mmoral0l perwnd ilan M1cm the ContainBr ar henme Rmainsdme OMxased PBreoNllMna mRIn 1M /µrtWMr or Wm me MTWs fall batlMiroyed My fats m cRNlm nt payment a fNM n M H wry they Amami y Y 1/."'�r NW heraOy auNomze PINE VIEW CREMATORIUM '°""""a" maem.teMarwd.irte ama demeevaa u(nA OPTIONAL) IM2 moral Measure me Mmed furenl thrasher m gMWe for delivery m ant Managed oy an aMmate OxntleY.H deemed n mensi In the opinion a the furadel Miami ant m mmMd MM form m moHdO Me correct name and some d boon alternate cmnatwy. FINAL OISPOSIIION The Ponwl aOg mPepsi tl'eventamd mmems of Me Oemae00(land Me PM se Name: JAMES P. Mc9ERMOTT OR EMPLOYEE AWraw g PINE ST.CXESTERTOVM NY IM17 Phwe' S19Ag42611 The aenmed remmna or defauea NNI ce dspaead d M 1wM.M'. AM I"i n m ant teawn Ise pawn damaa may.Mar m tw pmBSaka d Ma pwdated mnr.m.. PINE VIEW CREMATORIUM iawMetra w"Gmeeesisnd "i sees Vq taneincm BARTOWMCOFRMOTT FUNERAL HOMEdNC. federal P+warwawl hlprwnw by reyamred mail. IpWMOL FNiMER Mvo� OOSiBe&I(Rev.OLIDI Peg02N5 Authorization for Cremation and Disposition /node Mehamwmg) mra understand that it me remains are net aelmea WMln 120 days of aemarlon PINE NEW CREMATORIUM may dlapuee attre remains in mrawcei an Ideal manner, such as by ssMwerm CREMATIONCONTAINERMURN inineIl ONE of May knowing) An um W as usM as a manpower for Me moral remand has Oven purUual fain and is aesmeed as fell Days monsoon NM O me us, Is foo small to head the el acnated farmers, an a]dNmal and Wnlairbr may an used W delivery 0 y_An um a nM ym purc amd. WJe wderslaMMa[i!ro um Is purmasa]a Mavnea pmvid00 PINE NEW CREMATORIUM vdll FVeW Me tlamaled remains In a ned demands,rendmar for d•deadry a �' This AUNwu Form was provided Ey JAMES P. MaDERMOTT was esB wet SARTONMNERMOTT FUNERAL 101il NG rwamnvxw p..u.wx... 9 PINE ST. CNESTERTOM NY 13017 and is agrrttl by tta all director sa aiMees to is execution IM/e here Moral a con gaed way of had AUMarintlon Form. This personae)Nandi dabw Ware Me pore Br In Mali MdNp on,won My mall MM ArMwh nFarm,at S) a Me am army and mmpltnese W Me I ntarm Um command In MM AUMMaedon Farm and aW rheas)1ha bran. Migned Mla 19TH day of SEPTEMBER n n JAMES W FARMER m B27tNYEBBURG R0A08FANi LANE NY 12815 r�-mamr+w+ l^sens+. L DERMOTT HOWARD FARMER DOS-fill(Mall. (iii ✓ Peal