Garrand, Shirley Pine View Cemetery g Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOMe:
__.__-A"nNaEa ..
--- - - --------_. RETURN TIME:
DATE A TIME REMAINS ARRIVED AT CREMATORY:
NAME OF FUNERAL DIRECTOR OR RR EEGGRR/ETCCR�pICO RESIDENT DELIVERING REMAINS
NAME
TYPE OF CONTAINER: CASE #
..yam___ _.--�°_.._ 1 PLACE of DEgrN: rc._----
„ _ ._. N'.A�_. __b!
ESTIMATED WEIGHT OF REMAINS 6 CONTAINER
PLACED IN HOLD; � Y6
PLACED IN REFRIGERATION;
DATE OF CREMATION ---
__._--__Ll
TIME STARTED:
ECOMPLETED; 114(A
q PLACED IN RETORT yv_30 MOVED
RETORT 4 IN WNIC H R EMAI NS WER E CREMATED,DET _ ___
.. ..-.. F- L._..MI REASON FOR DELAY IF REMAINS WERE C
FROM
TIME
REMATED MORE THAN 48 HOURS
FRDM TIME OF ACCEPTED DELIVERY:
NOTE THE CREMATION LOG _ -
�///-���-III OpeXnw�nl N5M1
�J NEWOF YORK Division of oNolox DFceaErsRla
j�1SIT5ATE One Cammwaewau
°"°" "" Cemeteries
w'.le,atPl66]M
Authorization for Cremation and Disposition
This Authorization Form must be complapd and signed prior As UVIFrery of romeine bar assembler.
Dead: 081 Wismar. 9Sz
pmnalary Name. Pine Vlew Cremato
Address. 21 Quaker Rd., Gueansbury, NY 12804 plpr+.
CpELW IB AN IppEVERBIBLE AND FINAL PROCESS.
IXBr On IS armed rid by plating the remains of lee deceaud and the container holding the remains into a Moroccodwmf whom
they are Subjected to homes heat and name. The hM and name will Inclnerah AM emmume sysry IN aauptbMe YM meth,
whim are all that will b left After OemaXon.
Folbvnng cremation, the crematory,Soil take reasonable efforts to remove all of Me remains and other materiel ham the uemation
chamber, but some minimal dust and residue will likely be lit behind. The crematop wiY separate Inudental and foreign metard hwn
Me remains end the InudeM l and breign mN nal mll oe disposed of ab requirM by lac. TM1a tlemelM remainawill ch meManinlry
pulverovidim small pietts and placed into a designated Mnonera um. CMoWmaingenanlly2mpuMr unim
single haymxd is recognizable as s"a loam.
OFEX NO OF THE E CONTAINER
The uamarory may only open the wMacter holding the umoem"human remains in llmhed circumstances, sum as WrMrm the
Nemiry of the demased or to ensure that no material is exlmW which might Inluro employees or damage the rem"Proped6 rc
human remains are dallverM Ina contanerwhlth 4 May suXable bFCKmaeon such as cMmonlal or mM l"am the
rsnytary will mquire May the ranwins be Armed into a euMble Cantainerb M highways; com remains. Thecgoing Ma
cadmium orthe transfer orremowl dremain ,Sell be canceled left wmmess and wil N dine in pmary,with deny and respect
OEM F CATION OF MCEABED
Wmeomewaved: Shiley Gartand Xwhal Saba, Manned
tan Known Address: 5699 State Route 28N, Nagai NY 12852
plan a D M. Eltleinvoi M North Creek, 112 Ski all Rd, North Creek, NY 12853
see: ON 19F No 64 Doe: 09I1(fl1955 a dD ,, BB129I2020 EsnmaWSYerom lye
Dssrnphon do kWmftimr in which ro Nwill N deliveM.
Florence Casket-GNuxe Container
pEpa°X X CONTROL OF OISP°SITIDX
(Farem(a)in cwAd ddapsltim, ONE or Ma MWword
1 andWe ere the designated gent of the dNAesed designated I n a mil or written ,more em Smorea pursuant to Pi
HmM law Mmd n 4201.
P1M1Nam ha no knowledge that tire decomed exe a women inMmBM command M public Heahh Law Sectio
n a201 «a
l wMeinlne a rMiorm for Me aomenten a he or her remains and Irwin are the perform)flowing plodr under public Hwlth Isw
Seaom 4201 and have the from to aungtae vemaoon of the remains ofMe managed. Mi MlegomhlP to IN dscsssed Is
lotla s
Shirley Garrard
DOS-1898-f1Rev. MRO) Page 1 of
Authoriution for Cremation and Disposition
N umer/mm the list deal
Number 2 Decontrol Sum iyin Sponese
1. Apnaon designated in writing pursuant to Pudic from Lax Bation<00113);
2 The surviving epodes;
Y The surviving domestic partner:
]. Any surviving mile eighteen were of age or doer;
<. A surviving parent,
S. A her sibling eighteen years M age or olmr',
S. AlaMully moused guardian',
]. Any persomileighteen years of age or older emMed to marem the estate and who lLe2 do tl0 Aeftermip to and Mohamed;
8. A duly appointed OMuciary 0 the MaH:
9. ACbee friend or Marine who hers executed a written statement purauand m Public Heats Law section 42019);
10. Achy N®I order M a manN or a Wded aremember thereof payment to the Submitted Court PrOmi Act
1oa. why Oder Mmn who'toads% On MhMol Me decrased eM who her seemed a winner statement Wrauent b Public Health
Law Sebdn azat(]).
(y{11hill �LLTHRFE(bmokAwq)
(Lff AVe metal affirm that the may of the Mahaaetl does rM mo namany. battery pack power call radwel implant,
or eewhere daubed and tin any such mroidal were beyond prior to deal of this Automation Pam. Firestone to remove
MwMd djome prior No bedroom may rash inform to the damson and Metal pm chi.
///.S/ IM'e earn Mat mdmtiona New been given to Davido Aritander
regarding Me removal of any wmnel prcgrty ch order Wrq of dew wfYdr may pmdn opera below or any ready member of Me
denaed wishes to pm . core View Crestratorrit
emi
is not membranes for Me removal of personal hereshwneN w neror%M the emmm ofeN deceased PmOmtNme int
cpo2ns�tuivr or wits the warrants will ba deco 4 the turmoil yowl OW canmt beMatwed aXe mmatian
of Mohxebyautharom FinVIM Channe
xvml to modeler Me ynwhm are dmaeuM.
Ili atOPTI(l
Its honor authony the named farmers McMm to provide for contrary to and Channel by an ammass
Zion ter, ifMemsdnecessaryint oonhonof Me den ldie r,andWamend Misform Wprmlde Mecorneal sweetened
of such tlamee cy stary.
FINAL otsPOSITION
Its perm automated W mmNe Me aey remains of the Moral M1om Mammamry b:
Name:Alexander-Raker Funeral Home, Dead Alexander
Amass: WN Men $tenet Warrensburg NV 12885 pone: (518)62b2055
me mmwNaNna W Mee will N dlapxd of as Whom:
Return to lamp
If bar any been the deacon hayed serve deals not We possession Mite me remains
Pineuew Crematory is auMmiad to give possession of
ceases,see
Me remains Alexantler-Baker Funeral Home by revery
Nad
in Iemmorbsreis men. tannery Gatlard
f10S-08981IRm¢0i2o) va.xw deal
Authorlmitlan for Cremation and Disposition
r��w&w��uyyra rwmwxrml
/0 MunU nd NOff Mm=ilnsamnddaimWtl hln120MyaolmmWn.
Pine Vow Crematory mry dupove MMeremeim in
an menswebk manner such as by xBMlNp. ec..wn
GPF n)H LONTAMgMURN
(�fONEo/fxs Wowing)
Alexantler-Baker Funeral
An um to be used oeconralnxla the vem&M remains has been purchases M1cm __
and a aescnbedi as folbn'
lose andamabM to X me un 4 W asset g Mtl Ne ends oamaba remains, an addNmal rgp mMaier may be u MdNMry
OF
7� Mumbrwtpl FurcM1eeea. Wle uMmlend NtlNm um upuUraxdw Nrerv.+ee proNdW
Pine Vow Crematory vrca peace was«amend moraine in
Fw..aord
a NM dominating wMelnxfor centers.
This Adaboaeamad Form was provides 4 Davq Alexander Was eedaelst
Alexander-Baker Funeral Home
380E Main Sbeet Warren
M issburg NY 12886
e barred by ere funded dlragentIN ar as age N assi nM�u.
Me have Wood a wmpiaM mayor this Authorization Farm.
no penenls) lantM babes loan the pendants)In cannot orabposMwr,who by ermine this Authorizations Form,boosted)
dote accuracy and mnplMeness Mthe Imonnation demanded in We AUNwIeeOon Fwm aM suMorbels)the bramalnm.
a 20
MaNh 31et sera August ye ��
Michaelel Garrantl
8699 Stale Route 28N, Newcomb, NY 12&52
ideas
a11MFBa: /
David Alexamler
awwawm +ro.esmeexaw a r
1 W34
Shirley Gamral
arsw�a
DOS-189V III Osi Pre 3of3