Abbott Jr., John J Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(578) 745-4477 or (516) 745-4476
FUNERAL HOME: (Yl�1c /rHV
_.....____.__... RETURN Tlme;
DATE B TIME REMAINS ARRIVED AT CREMATORY: -ZLl� ag7n
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
./ ---
NAME: J11 q
/ ) . CASES
TYPE OF CONTAINER Y/ le —� -_�-
PLACE OF DEATH: 7
ESTIMATED WEIGHT OF REMAINS g CONTAINER_.__
PLACED IN HOLD:
PLACIDIN REFRIGERATION:
DATE OF CREMATION:
TIME STARTED: __/P zs'ym_ _ m
TIME COMPLETED: _ )Zj
—.. _ .__.. /2
PLACED IN RETORT: /d
_ >-S/}n ..._____MOVED: _ --
_l.__ lM--___ .RETORT Y IN WHICH REMAINS WERE CREMATED:
DETAILED REASON FOR DELAY IF REMAINS WENE CREMATED MORE THAN OB HOURS
FROM TIME OF ACCEPTED DELIVERY'
NOTI: THE CpEMpTION LOG SHALL DE RETAINED ;N THE PERMANENT FACE OF THE CREMATORY,
Pine View Cemetery and Crematorium
21 Quaker Road
Queensbury, NY 12804
Authorization to Separate Cremated Remains
Funeral Home M B K'Imer Funeral Home 136 Main Sweet, SOF NY
Director Clare Konooka p
Date Aueust 25 2020 TV No. I �0 AI
hwe announce the sepazation of the cremated remains of John lames Abbott Jr.
Ilwe banner agree to bold harmless, indemnify aM defend the herein named crematorium as well
as their representatives, from and against all clams, liabilities or damages whatsoever which
may result Rom this authoritaatiio�n..� }�--
Signature l/=`�KI�� ✓cb'GlT'1 / c<,
Crematory Operator
aSah MIS
//��II ON OF CEMETERIES
—J Na IT
EW PORK pIVI510Il Of Drvslon oust gMETFnMs
OPPORNXItt. Cemeteries 99 Ai .NY 122114001
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Authorization for Cremation and Disposition
This Authorization Form Must be complebd and signed small delivery at remains for cmnal
DMe August 25,2@U Number.
Cmmab Name: Pme Yew Consumers
Address'. 210ulyr Road Oueene q. New YM 128" Poore: 518-7I5MP
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
Cremation is canned Out by placing the remains of the deceae and Mecontainer twenty the remains into a Oemalion Chamber where
Nay are subjected a eterue heat and flame. The Heat and flame Mi lncenembe and commune everyMing e4' rooms eM might.
which are all Mat will Or left aasr cremation.
Following vemahm, the aemwVy wit tyre reasonable eforu to remove all of the remains and other well worm the Cremon
chamber, but some minimal dust and residuewin likely be Hall behind. The cnemM win separate imcdental and ensign natedalhwn
Me remains and Neeudemel and Human metHlM will ce alsp[mbe cams required by law. Te =e edremainswillbe Ma win lly
plumbed into small pieces and placed into a designated Consumer Drum. CmmaW rmislm wrnrsny arc puleenmd un i no
shots"¢ ant Is recognluOlm as shalWl tluw.
OPENING OF THE CONTAINER
The camakry May only open Me consumer nothing Me unuemmed human remains in antM tircumstances such as to antes tin
All of movivarsed duo ensure Met no material is endowd voich might rose empioyBea or damage the vemaery prq-.edwN
human remnm an delMrM in a ca inw which Is not suitable ran moral such as Common III or rend CQSk me
commeary will uim Nst Meremains bmvM eo lM asuitablecmdinvb6 mitaccen Neremains. meopeningae
rsq
airreror Me trenMer ar removal Consul"it be miducted bel a where and vnn M done in pervacy, MbdiandyaMmg .
IDENTIFICATION OF DECEASED
Name of Decimal John J. ANaR Jr Mantel laws Drvmmd
Last Known Abdul 25 skyee Apt.A. FM Edward. Navy York 12828
PIMA of Dvelt 25 SkyWd Ago A Fort Ed rNew Ydk 12UB
sop: pM pF Me. 53 cog. 05-12-1967 pare of Dea M-24-2020 ENimaiedw M 150
Desenption of®skevoaMairer in which remaire ton be dNirered.
Florence Casket, plywood wrrugated Cardboard container.
PERSON IN CONTROL OF DISPOSITION
(Porsm(a)m mMml o/dspa3inM.�i i$I ONE W Me fiWoruug)
I aMJJe are the central agent oftie discussed designated in swill or wrimn ImsMmaM whom ed pursuant to Pudic
Health use Sechon 0201.
�c I1 L m kngdedge Mat the deeased assumed awomen instrument pursuant W Public Health use Session 4201 ors
wF wMainN directions her Me oriental of his or her mmyns and Ito are Me Comfort) hmmg priority ured PUNIC Head Law
Section 4MI and hell Me right to authors aenutern OF to remains of the deceased W Our relationship to Ma mwased is as
foiews:
John J. Abbott Jr.
OOBISM-f(Rea OU20) Page 1 Of
Authorization for Cremation and Disposition
preed Man the Ilat bi
Number Description. Any surviving aid epMean"am of ape or older.
L A mean designated in wetting pas t to PUNic HealtM1 Law SxAon 41
3. The surviving spouse.
U. The sumnse domestic partner,
3. My mrvi'nng Than Merchant years of al or older;
a Aeterval Wrest:
S. Asurni sibling aghlBCn "am of age an older:
S. AlamMlly appointed guardlm;
T. Any perform) eie en yeas M age or older entered to mare in the estate and who naive coast in idealip to the de¢ased:
S. A duly apMimed fiducary of Me estate;
2. A shape frimd or mlaove unto has executed a whom Most formal to cargo Hearth tbw semen 421
10. AmIN Mwl officer M acounty or a public administrator appoinlad formula to the Surmpalas Court Procedure Act,
10a. Any War pmean vitro a acting on behalf of the Measured end worn lees executed a wmlen appeared puraumt to Public Health
Lax£emon 4201(T
(�d1A WREE ofthe monsoon
IAye hemby affirm that the body of Me demand does not contain a reaMry, assay pack, power call ma,mdiW implies
or mdioactire device and that any such mormal¢were removed after is Me execution of this AUMaitatlen Form. FylureW remove
Mesa prior b approval an" result in be"to that ry cmata and crematory persanrrM.
affirm that instmtima have been given to Class Kmopke
regarding the removal W any perearel nopeM or other thing of value wrich any part aligning Mlow or any baby member of Me
deceeud waMe to pmwrve. Pine vim Connote"
n rid raaporwide(ortM removal of persorelilem¢M1om lM1e wmairerorM1wn Me mmaine MlM1¢deceesed. Pommalle s"in Me
C /alnw��F1CISM IM remains sell be daeboyatl b/the thermal and cannot ba moMVM abr amnation.
V`H w Mail trustee Medico a Pine Vlew Crematory
�creeneeenin
W cremate the rwnaMe M the dare d.
(evitsDvnGNu)
li hereby aulMrlu Me named funeral director to provide for delivery W and normal by an alternate
adma1Dry, It seemed necessary In Me opinion of Me tsunami dancer, and Wamend Ms form W provide the correct mine and
dress of such alhmate cremal
FINAL DIIP011noN
The perm supported to remove Me aemMed remains m the decreased hat Me rura orY is:
Name. M. B. Kilmer Funeral Hama
Addefs. IW Main fit South Ghana Fells. New York l WX3 Prere: 518=7459119
The nemaatl remains of de2abd will M opposed of as to ssee:
Reused to his year DaNdaM Ryan AEWI
If far my memo tM person named above Mw not mite permanent m for aromatic maalns.
Plre Nex eremebrY ,sfederal W give pwsman of
w
,he rerru'ryW M. B. Nilmw Fumal Home bychyvery
wuw oh
in pwxn or by repielwW mail. .kYin J.Abbatl Jr
tam
DOS18584(gay.DIRO) Pager 2 of
Authorization for Cremation and Disposition
Me
I aneeaummhm it the rannos are naabmee wnnin tzg d+va orarwnagw,
Pine Vkr Crematory
eel maydtpoc.of remamam
en Mwdeaabt manner, wM as by ewnexng.
CR eNF��F n`
(ICI ONE
�data Mbwlrp)
W'An um to be uaM as a somehow iM Me memories remains der Won purchased wm M. Is Mlmer Forest Hama
and is described a told. GranXemeb Metal Red
INIe understand Mat it Me um is iw"I to hard Me arms vcnaled remands.an adi Ronal Mild wMairerR ad be used be dervery.
-OR-
Ad um he not yet pun . Vft wauYaW Mal it no um is purchased or oMn wprovedea
AM Vers,Cheri wall places the estimated remain In
a Ind tammrery wrxeiner he MINI. punw n
The AuthMnaen Farm was entered by Code C. Kmopda was executed at
M. B. Rimer Funeral Hone vuevwsvxsm
135 Main St SOWb Gone Felt, Nevu York 12803 sw.wx�r.
and 'a signed my Me bnerel director as vMress Is its ux hon
IMh have emrvad a wm rstd copy of this Awmadhatlon Farm.
The parsont Identified babe,iMae Me parental In seemed of disposition,who by signing met AUMwhatlen Fame stuns)
b Me accuracy amid completeness of M ,Information contained In MW AUMaiaaaon Ferm and autdo idle e)Me bngeing.
Hpned Mle 2ft day of Apuuld ,2030
DavNNMwtl
25 firms M91a Read Gwsruoax Nees YOM1
Ryan AbNit
25Ken Mllt Roar GansvcatNWTOrk
rrwvmrve saw
oi
WITNESS:
Claire C. Konnpka i - C_�
r e.mnmu..q pu.vomywn.I
01932
Jon J AbMg Jr
crude
DOS-1898 r(Rev. CV20) Page 3 he3