McNair, Debbie Pine View Cemetery $ Crematorium
Quaker Road
Queensburyl NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME:
�xnnDfLl✓q[E------._.._..__.- RETURN TIME:
DATE B TIME REMAINS ARRIVED AT CREMATORY: Q lb n
NAME OF FUNERAL DIRECTOR OR R E
�EGGRISTRED RESIDENT EELI VERI o REMAINS:
�,qq�� pYrTDp -------
NAME.
--.. -- CASEp / 3
TYPE OF CONTAINER
PLACE OF OEATLN
ESTIMATED WEIGHT OF REMAINS S CONTAINER,__
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION:
TIME STARTED: - `)AS h--.__Tlm-"'-- E COMPLETED:
PLACED IN RETORT: '/XI Ai-I --"
—_._�'__. .. (:"': —MOVED:
_ .
RETORT Y IN WHICH REMAINS WERE CREMATED;
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE TH gR
FROM TIME OF ACCEPTED DELIVERY
NOTE: THE CREMATION ..LOe SHALL pe p[rgirvep IN THE FsxmnxEENT m FILE OF THE CRemgroev.
New lurk Rea
t OI SUY
SEW PORK Division Of O11^BlON a CEMETERIM
Ol S"I'll,.RIM
° P° R "" Cemeteries 9Me,m AeeL
Atorry N2a1doM
TelMme jRN4MM2S
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Authorization for Cremation and Disposition
This AUMarhauon Form must be compl"ea and sib red prior Fly delMry a M alna for mmNon.
Raw. CSQM2o20 Number IT
Clem Nm". FIM Vpw Clmnabry
Aabttu. 21 Quaker Fred, QueemW NY tzB3i PhMas (51e) 74541477
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Cmmation is mired oM by dwong the remains of Me demaaed and de cMbirM timing the emans Into a Gerreen Uumlrer where
theyaresuNec inbnse Iwatandname. The h onditm Mil bcbenie and mnsumearmrv"Ilne aeceptbone and meiak
x kh are all Beat will b NM1 after cromsson.
Follwnng uernmet, the r,mMi vdl tees,reasarebk etbr6 to lamow all of day remains and Other material tram Me uemation
chamber, but Soma minimal dust and rntltle MR INely be Iefl bi The Real will separate Incidental and rarely, matenal from
taw remains and Me madental and farm an ma@del Mn be disease]of as,rquieed by law. The cremated remains all be medmicalM
pulcehaM ink anal piece and pkwd into a dWna cantainar mum. CmmaMd romaba generally an pulwr until no
single fragment Is rxognmbm as,fdri W.w.
OPENING OF THE CONTAINER
The aemrtory may only obtain the mMainer hotel the un cremated human Retains in limited ciumNanps, mar as M confirm Me
sual Met mad or to ensure Nat NO mi mutual whits might injure empbyees or until be mm=R property H
human remains an dMlwred In a conbiwr which is nor cliuse for cremmon such as, re arrom al or rental casket Me
crematory*it regulm Nat tie mmaim be moved Into a suitable commoner Wore hamapm Me remalm. The opening of a
mMamerm Ne han vertu removal of Kamen Mil M conducted bekre a wiewm and vet be done in pdvey, vets dgnlN and reawd.
IDENTIFICATION OF°ECEASED
Name of Decers DdEk McNair Marital Statue: Manned
Lest Nnwnm PLSeas: 314 Ld Must, Ld TS, Saral Smonly NV $A6
Play off Saraby Nospml
New El El Age: 58 Dorf.. 08/18/1962 Dak MOWN. DaRaxmo Eslmated Might
Deempbon M mSkFmommner in whiGm remainsaI badelwra]. �
Cardla Box wMlooden Bess, (`Ubvp QCLCW- l
PERSON M CONTROL OF DISPOSRION
(Porson(y in Wnfml or tlla(mvLm. rvual QYEdfM1e 101bwinBl
1 amMb are Me dame nakl agent of iris deme dmi MM in a all or mM immWMmerecutad"cSuml b Public
Heald law Seation 4201.
IM haw no krgwkdge Met be des executed a women iminmeM pursuant to Public Health Law Seadm ant Ora
nteimnl isretliom for Me wommen of his or her nmainS all Are are the gnome) having pricMy under Public Health Law
Season 4201 and have the rigMbaulwnze oema n oftM remansof Na dwaa ftOrmlOonshlpb NedeoasWisas,
bnowe
Debbie McNair
DOS-0eg3f(Re, 0a20) Pace I at
Authorization for Cremation and Disposition
parer ban Me w bond
Numl 2 Donaldson Lard'61Glalr(Sp ")
1. Aperson design d l n wMng Wramet tO PubliC Heel low Gc4er10301(3)I
i TM suMNng spouse,
ga. The Surviwng domenic partner.
3. AM Unmoral Chad egncen years at no or older;
4. AaurvNirg parent
6. A sul slung elgnteen ram of age or older,
S. A lawfully appointed guaNlan;
T. Any persons)elghmen years slags No dull shies to snare In My stab and tent ielere rimed In lelatbnenip to VS de SWI,
a. A duly appointed fiduciary of the$title.
I. A chose Mon0 or re4sre tent has ResonE a Meen ¢bbmanl WMuem to PUNK health law Se on Met(7),
10. AtlnMond error of a County or a public administrator angimed pursuant b to SurrryM'S CWrt Praxdure Act
INS. Any osier pcvmn who is acdrq an behall of Any dM $e and who has mewteI a written$b eM Wrtuant to PUNK HeeIN
Now Swollen 4201(7)
(ImbNA L MREE VMS.HW 9)
IMN het Ay alarm Met Me body of day demeeed news nor rantaln a bottom binary teed, Inner tell, M,O% 2lmganl
or radloeNrva dells an Mat any such materiels were 9no E prior b the eaeumm,of No AUMorme Form. Failure b m me
tnae .h.��b�----///m/ e prior cremation may Mai In ham to We cm MW and cmmItary pemonnel.
MR,Am thaflmbuchons her been given to AlGHoag
royal Me remonl of also WMarnl prWeM a Peter llq of who which any Pol¢m mirg below or arty 0mily n rof has
dymmmkd MMa N premae. Plre Vew Gemabry
ie n0lrapOn9Ne br Ne removal aIPoMOmI npna Mm Me mnryrla a Mm Ne remem¢of tie CeWeaed. Pemonal sins NNin Me
M/.aaln/ear wwlN the remain will be desiropd by Me cmaV0 proms and cardsWro "ed after cremation.
✓' NVe FareEyaNnodu Plne raw CPmalory
UPS
b cmnsY Ma mneln al Ma CBtaaM.
(rawWTONAL)
IHn hereby auuada the monad Nnemi director to Provide for daiwry to and cremation by an aMmaM
Coma ,n deemed necessary In M.opmbn of Me Conan of rector,and to armed Mla form b provide Me cornact name and
oddness W one alternate crop atory.
FINAL MMSITION
Theparson tlw b,Mz the crematedm m M Me dwesW Men Me aemmay b:
Name: com"mmele Funeral
"MR CO] Maple Aw., yW l SpMps.Jay mr8i Pnme: (518) SBHBM
TM=MRa I ams Ofdemaedwli bedlerycaE Na MI
GERM➢e.N50LOMON SAFTOGANITONALCEMETENY
If WaM IYmnft Ninon nal l d notlaxe you lw&m oanaled r0nwrm.
PMa N¢wcremat 'a win he Few pose ion of
tha lmnailmm KAnwevml Cary nmM FUMMI Gre.Mc by delivery
In Common a b)Mgbhaed mate ex�,wymxva OMb1a MMN
OOSiag f(N GsftO) w Ppe3N3
Authorization for Cremation and Disposition
I me Mlowsgl
w.e unmrsWe mnirNeremama ere not chimed earn lzodayaot mmeNn.
Rre Vies c2mabry maY ahpmeMMe mnalrmm
an Irretrievable manner,turn an by,sneeadne.
CREMATION C(NNTAINERIURN
(�ONEoltlre/aMwnyl
An um to M Veen as oMlemer as day OemelBd remain NB been ryrUaddl from
art adesand as Mbar.
Add uMORb!-0hat if has um a Wo smell W how Na gran cremated summary,An addioolW read nMdr9 may,on aea]ror d&rvary.
`7� _MumbWyGpuMlmad. lr understandtnndroumispuMas «otrervreeprovidM
✓ � � Pare v,"Orematry colt place the cremated remansln
a road Wmprery immainr for delivery. Mmruunwrn
Thin Au@adsamn Farm was rammed by Ri G. main am mmissed at
CompassaalM Furerel Care. me
Q2 Maple Ave. Semi Springs, NY 13966
and is uomd q the kneed Arai as wiVewro ib immutos
IArm have resonant a completed wq of had AuehorY wForm
The pmanMl amended Eelow Wham the pemonis)In con\ml of Ai$p Wm,who by aid nine NY AUOorleallan Form,amaut)
W We accurary end somplNema of tlw InhrmatlM ensnared!In MW Australasian Form antlloWarlxa)al Me foregoing.
Serra Me 36A day or AWMI �o0p
Later MWNr � �
314 Wu]en Rea W 78 Sarakga lipirsams. NY )lt(L
Assisi
Awns,
WITNEMS
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