Swehla, Robert G. Plne Vlew Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(5'I B) 745-4477 Or (SIo) 745-4476
FUNERAL HOM O -
._ ftawNe4n
-- _. RETURN TIME:
OgiF a TIME REMAINS gRRIV EO qT CREmpTVRY:
NAME OF FUNERgL RECTOR OR RECRISTENto RESIDENT DELIVERING L m )REMAINS:
(PAK__0K-KAODE
NAME: Q, ..._.
._..Roes-- SUFN4A __.___--
TYPE OF CONTAINER - c ASEH
_A PLACE OF DEATH: Try /fit C lIWNIA�L
R.
ESTIMATED WEIGHT OF REMAINS & CONTAINER
PLACED IN L60
PLACFOIN REFRIGERATION
DATE Or CREMATION:
TIME STARTED: (�y„
PLACED IN RETORT Won
PLACED TIME COMPLETED.
_ _8:1AJIM - (�
MOVED O 40 p
RETORT HIN WHICH REMAINS WERE CREMATED 1 p, ;cN1 Iy1�
.
DETAILED REASON FOR DELAY IF REMAINS we2E GR[MATEO s'fftK } IB �
FROM TIME OF ACCEPTED DELIVERY' MORE THAN 00 HOURS
NOTE, THE CREMATION o -.... -. _ _
L OL nLF R THE PC
RMAN ENT FILE Of THE CReMATOpv,
o.wmaentaORMS
DIVISION Dip CFM It's
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wivadMoi
Authorization far Cremation and Disposition
T WAUMONae Form mwt be considered and shield Briar m delivery of Maim for emm On.
Dwar_q 1L2020 Numb¢
l03
cmmamrr Name. Pine view Cremino Phme: 8� INS
Miami 21 Quaker Rd. Q1 mensti irf. NY 12804
CRFIIaTON IS AN IRREVERSIBLE RHO FINAL PROCEss. and the=0=wlu
to
*no wool],
Domedcn'a ldm t Permit ta� n comorther whom
go flamB�ThafFNt am Nm1ncomand amarylMnO onfloPome *no
w
wFlmerth a an mad inn N mR emr pmw son.
ramwirq amwmn.ma mamamn who mrs reawmue amnamame and emermatHiallrem ma cremhim
the rebmarin.M uemintlae�l a e Meq^moon all got ow Id®pwawl mT1e r�+e1^acW nemn'ai a'nemvnil 0e mMittnenlosuveved inmsmall pwzs and pleuraInto a dNyna�containnlmlm Banaft am ad Von
no
Ingbhv0nlem b rectanbabto as am WI tinw
m m -
CONTAINER
I me mnmma.Iwumg ma w-wm.w human winnow in limited ck ma
�mamn , Such N w l° mrmt n
era fiecainat M"0e0ly
Volume,
rcaa eHenU ensure
a weitteiner which nM us WN1alnrcreln:i on aupc°x ae xlelnu�ml arnMel wV Ne
The
mmem oda rNWre Nrt the rwmim to lnovtl inm a suJaUbcebega band oewAe tx privem.Woo ai9nily and rcapecl
conversional bammr V relruval of Rmeins will be conducted
bMo1e a wAMcaaM Will be done in
�p
NamealleWsld: Robert G. SwillMiami Sttua: separated
va Nmxn MaNa 54 TrippLake Road, Chestertown, NY 12R1]
Plam ell Beam: Deceased's Residence, R4 TripD Lake Road, Chestertown, NY 12817
floc ®M Crisis. 45 DOB: 06I2011975 pate a Beam: 0911=020 Eanmeted welght 250
Dearmi a chromosome N,whiN among cool be deFvalad.
Florence Casket-Deluxe Cremation container
(ormagg )in cannot o(aapuaron,mAdid DYE WInd Hawing)
I emM1Ve ve me bzgnatsd agent of the damaged damaged! a WII or shown Instrument Nvubd pulwaM to Public
Heart taw Sacton 4201.
-OR-
e him no knowledge,drat his dommad
d a women instrument Pumuard to
will mmYning Mond il W me Napuron a no or hve xremeim Public
and loan M e so, Parsaonem havng pnortty under Public basin Lawoea
xb Sen 4201 end have Na heh(m aullmit,normal aQm remains a the damaged. MYlour membership toms dweaeed ®as
blW
Robert G. Swehla
Plate 1a3
pO I$Wf(Re, 04220)
Authorization for Cremation antl Disposhlon
pwdemnms 9nlwmre
Nuwbend Dancmnon:SigUyi Parent
1, APolao'i tlnigmwQd in whing pwauenl to Pudw XUM Last 301m ag,(3);
3. TM suMNng spowe;
U FMe waiting aomi Partner,
x My sumili chile elgMeen n of ape«oh0r
a Asurviing panmi
S Asrvilig sieimg eiemeen years a age or did,,
0. Alawfully ygoim Midland an:
f. My Panama)eytwn years of ape w older entill "has In me eanlO and and iLare Ck t In admansnip to Me Ceov ;
E. A MY,elaborate fadi of the mats,
9, A dose hound or nlative who has executed a written statement pursuant to Public Heats Lew Section4201(7):
1A AMWMail officer N e county a a public adminbryator isacomed punuem to Me Sumspen a Could Pmu]um ao
10a. My Met person who is au ng on nine If Of We deism and who has executed a wiimen ahtemem punwm b Pudic Hearn
Lee mpn 4201(7).
(SAL TWEE of we Ask,antic
XPMT r' 44Ve hereby affirm that Me hMy Of Me beza90d Does not amain a Wtbry, battery pad, Posner call handsome Implant
Or nfbcWO Dena and that any each meterieb w removed Wow W Me necirion of Mw MrlharzaY Form. FtlWn her o
qw Mans poor War cnmatlan my mua In harm W Me Ctrs and Cmm prwnY.
XPMT_4Ng amm Md mannolons have con green to Davitl o, ndMr
regarding We reacts d any Mn 81 pgprty«plher thing of vale wash eery p n 69nirg below or any luny nlmmr of Was
deceased wishes a muses . Pine View Cremate
b not responubk her W nmpyM Malawipnontl Items h«nthe antainera h gamainsdtlmdeCe W PasanalY Its Inthe
conminer arwnh qs mtlre will bednhoyW hype ematlon pwew uM umotq nrMvad abraematlort
XPMT Manor au oa Plnes View Crematory
v to cruun Me remains dw deuaaq.
dgmt O Iltia; )
Ian aenby withdraw the named Manuel dlrecgr to provide for di to and cnnudan by an aae
Gd . If mernateed rec CrdsginMe son nlan d the rural di dean,atm to amend M in form to pmapedn cornetname and
FlNAL DISPOSITION
IMe pecot awhednd q mcNw On vunyd nMWu of qe downturn from We Uen u:
Name:Alexander-Baker Funarel Home, David Aexanber
recall 31K9 Mein Stree[ Wil"naburg NY 12M phone; (518)623-21XB
Live aemared mmdm ddww win be dip domiM
Retumtofamily
nranyn.ontlepenen nmmaahaW con�gttea PdaOeeN«i orgeawnawa rmnenm,
Pine Yew Crematory Nw W« WgMposawsnd
mwrawn
ft mimw AexenderAaker Funei Homo by dNwery
w.r�
Mp Or W Awaidered man. naww
Robert G. Svmala
ftradwadwas
W&1661(RW_04120) Ppe 2 dJ
Authonmilon for Cremation and Disposition
._ lmsYneya�m{wtul
XPI�r �1Mb unEnsrsMthy Iltln mnelns ass mtdelnee nMN 120 Wyagc amelbn,
Pine UawCremeto mwdiaprea Mtle mmynem
en lrmldwekle ivnner. edrwayemWlre. �itl
DRFLLtpN(ARTeu
l�NOMEMIMhWwMp)e
An um N towed age a onnlaNer fix"cnmaletl mmeire has barn pumAleuC M1pn Aa%am er-Baker Funeral
eaM a eavahtl n binn'
Inve Understand Rst rctlw tan IF bo amY b han the again vemayb renew, an anent Vd unWwr my M mtl Wd0mary.
XPMT PM i.eptMpuebaaed. INfe uMeMenEtlW XmtenkpadwxdaroMerwie pmMed
Pine View Cremeto Mil place the cremated ranamsm
nw.rdnw.wn
e 190 Wriest canister ter d&Mry.
TFYAugerhWm Fwm vns pmritletl ly GEWAlexander was executed at
Rre+otiucan
AlexaMerAaker Funeral Roma
T:n
3a09 Main Street Werte'nebury NY 12995
male r.
slag b+rnd M rlwrvnag.l arecwraa Morass m in exemrenn.
Me bm rssav aampktMa athis Authorization Fen%
TM pnar(el Intl W WIM Ware the parental In cornet dlnpesRlon,wlw by ngninB m4 Antlwrue4m Fmm,antenna)
he IM Va uracy end Completeroes MMe iMwmadon conWrrent In this AuParsaaon Form eM euthanasia)nb"ohn.
Sgnst Mb t�th dwa September . 30 20
Patrida M. Tonnesen XPathricia M Tonnesen
1 MMiaty Valley Lane Ellray, GA 30538
daae.a,. ww•
tattletale:
David Alexander
w.m,7wroanrxaw
10034
Robert G. Swehla
DOS1d8&t(Rev NnG) Pape3M3