McCarthy,Alice Fine View Cemetery 8. Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME; pp�� y
----+R-.. _.YILNESL...._ _.__._._ .. RETURN TIME:
DATE & TIME REM4INS ARRIVED AT CREMATORY: ..
NAME OF FUNERAL DIRECTOR OR REGRISTFREO RESIDENT DELIVERING REMAINS:
_ .. p L� pp
NAME:
__ __._._-?C 1Vb4"
CASE p
TYPE OF CONTAINER �f�mill:
PLACE OF DEATH: _
ESTIMATED WEIGHT OF REMAINS fl CONTgINER_ _.�
PLACED IN HOLD:
-�O
PLACED IN REFRIGERATION;
DATE OF CREMATION:
a' 7q
TIME STARTED: ___ (o:
---- kM L�.\/__TIME COMV LET¢p: ('
PLACED IN RETORT: 1p, �Q
. _MOVED: .
RETORT p IN WHICH REMAINS WERE CREMATED:
DETAILED REASON FOR DELAY IF REMAINS WERE CREMgTEp MDR— Q�THAN B HOURS
FROM TIME OF ACCEPTED DELIVERY:
NOTE: RR CREMATION LOG SHALL Be RITNNCO IN THE PERMANENT FILE DE THE CREMATORY.
Nowir York SUM
EW YORK Division Of omisl oNpM,"I"Fum
N TEOF O efnm Wxe
°FP MNM Cemeteries hl'"At 1,
Above
imlemnSo6
Authorization for Cremation and Disposition
This AY~zn on Form must be completed and signed paorto"iaery of remains rotes Won.
Dere August 19,20M Number 5'Sj
Crdnatay Hame' Plne�! Cremelpy
21 Quaker Road, Ouansbury, NY 128M Pbom 5184454477
CREWnON IS AN IRREVERSIBLE AND FINAL PROGESS.
Consu lon n carted out by placing Me rename of Me bens and They wnpiner your the mmais Into a cremation chamber where
they am suGeded symbol heat and flame. The bat eM flame will InNmnb nd consume sysryl ing ass oWine and criminal
xTmh are an Ma will by left after cremation.
Followed freedom, Me crematory"It take reasonable eROrob remoa all orthe remains and bitter maredal from Me Promotion
amber,bid sire minimal dust and residue sell Welt'be bM1behina The aemebry win separate madantal aMfomien mabnal hem
theremainsand Melmdenblan0Mmgnmatenalwillbadlp ofmregdlredby lax. The=Mm r al WMIde Oni[any
pulreriaed I=small pieM and plePrN Into a designated cmdlmrame CmmabdmmslnsgaamiyempuMrhaduMtno
deaf consumer Is mwomb ble as ksletal guua.
OPENING OF THE CONTAINER
The thermal may only open the consumer holding the unaronaled human remains In limited crwmstan a,such as WDarns be
tance is encloses darch
injure emplo�or damns
he MMM�summary,
hhuumn rely omoains am delivrede decreased or P nIna ulhlnersure that rej awMoh Is not suitable for�cretmadohush AS cerebral Yltwmi Sabi the N
cremattrivial require that me remains as moved Into a oulbhb conNlnerwbh Raapb Do manki The oMiN of a
cmtamer of the transfer or removal of remains will be conduction before a wtlre ands 11 the done Im poets winsdignityandresllaQ
WEN"FICATION OF DECeiED
Name Of°osaad:Alien McCarty Marlbl 5tnn'. Wdw
18u Kwwn Address: 20 Mnn Stttat Glens FeW, NY 12WI
Place M CeaN. 266 warown$hat Gam Falls, NY 12801
Sm: Us OF Al DOB: UH /ii Dab aIMM.CBIta2020 Eatimab] ht 160
Document of uekegmnaimer in which remains inn M Mivarw.
Minimum Cremation Casket, Florence Casket Co. CardtwardlPine
MN N CONTROL OF°ISPosmd N
FM am0u'ordnormal. Sure CUP orUp M1%mmp)
I ml we W da gin agent of the dowsed designated in a wal or Yemen samurai executed plmum b Pull
Hal taw aecSA 4201.
makering e hau9 no alowledw Nat the dnawd meculed a Yedan instrument Pursuant a Pudic H M Law aeCtan 4201 of
remains and
am ow�n(s)having prioner under Public
II Iaien
Mla��n a formation�oraemhis or cronat�ofthemma sofMed 5Ad WMurmloWnehpb Rhduaanto Law
eadlsee
rolrow
Alice McCarthy
00a-189braiev. ucag Paps 1 of3
Authorization for Cremation and Disposition
(ngQlpUr{IM aM"i n ima 7k 46r
S�
1. A arson oesgneletl In wrenO pusual belie Hqual woman 4001(3):
z TM¢arvrvma spouse
2e, fore suovire domestic panrar;
3. AMiummig child eigntwn years of Age or older',
l Adayrong pm M
5. A auMaing sblund scMwnyeam of age or older;
S. A Mwlully appeal guardian;
]. Any wrton(s)eghtemn years of age a,order nodded m sham in the merged and who Nam named In Mtl shb to My MN ,.
S. A duly appointed Moms Of May estate.
p. AClow Maid or relative who has swamped a writlensttatemmrt pursuant m Purso Heart few Section 4201(7)
10. A MleMOl Otfider of a aunty or a publb%mmoml appointed pu ouant to day 5urnpate 5 Court Pnceure AM
10. My Wror Osman who is same on behalf of Me deceased and who has executed a written statement puouaM to Public Health
Law SCMn a2atpl
pLL THREE ofde or ing)
IAft hereby alfimt that Me body of the headed does nor consider, a behery, wages writ, Pnwm fall re seems implant
ofra]iwtlin bevral and Mat any such mTeMls were reanowd prior to Me excal M Mis AUMOMa Food Failure to mmwe
M saw Item prior mrnnnel may mult In harm to daycmmaWry and emmaWry panonwl.
IMk ace Nrt imWMom have been given t0 Tend G. plmer
mgardir g Me wall Malty pawnal pngdy or Abler Meet Of vyu which any Orman signing bekwa any Rrmly member Oftle
deweMd vAsfasW preface. Mans body Carol
is not mepomiGe or Me real M seasonal Items hash Me wmalmr or ham the remains of Me deaese]. Pemmmt Items ll In Me
ni lIW or WM Me mmslm"it ber G "ed by Me cm am pKKam and cannot be mMeved After cmmal
Me dwwy auwodw PmVewC dM;d ry �.mt
W amounts Me mmlm M Me dwmsed.
In(n 0"TIONAW
Ant Mmby importer Me named funeral dancer W pmvl0e bar dMMry W and carte lm by an ammam
rsmcery If dwmsd Mca ary In Me opinion of Me fumml director and to amen Me form W provam Me comet name and
eddms of ewh derma de emmMq.
FINAL OSP08TION
Tor wmnl thermal W rewivn the Mmeted remains of the deaa¢ed rem the MMMory is:
Name. M.6. W mer Funeral Home
Ads,. U Browway, Fa W,t Edx NY 121128 Phone: 51&]0]-@09
Toe aemMM MnaW M dex wall the dmp Mm WIM'.
Cwermwnt Cememry.WTMM1aII, W MCI
M far am 1ema1 Me Opinion named abuse dealsnot Were prows &0 that IeM remams.
Fare VKe C mpaq p euMvized W 9hm Wsseubn M
Me of H 0. pane Fumed Home ['mmsMrem or dMMry
in Oman or by Wa6 mall. vuwwsshowM[CNhy
0G5-100bf(R WIN) M Pegi
Authorization for Cremation and Disposition
Me Members)moatrsta unaeral W W 111 remelron e hind darned within 120 days of Mammon.
Rre WwCremarory may embassy of May aneiroN
an iMarmsets manner.such as by sbwmes;
CRI YODIM CONTAINERNRN
nnmN ONE ad.rorowam
M um Tope baed as a sweater N tle aamataa remains has been purclmW hem
andmeggeaerrown
NMe uMnemM NN Bale um p ko small he pm ale entire demand snare,an WpoMI tars s^ra tar may uM ror WNsy.
M In is not yet Purchased. IM1W understand lost it rm an prchedsd ar Massive,Prevail
send Wx Cremtlnry vid pies the chairman mmmimi m
a rgwumpaelY container roraliorry, ps+rnon+nl
This AnnwNaPon Form was annealed My rode c. Kalmar waseaewadal
Is B. plmer Funeral Home 1rMwamxmu
82 Broadway, Fmn Edward NY 12628 6xw+w+xw1
and '0 Slo ed by the Mineral diRcmr as vnmmsa to by Moment
LWe have msivad a mmpmad cony of HIM AUMONaetlon Form.
The pnaon s)Identified hebw IMLtie pmores)In central W dlsrysNon,who 4 signing May AUMONeuwr,Form.aNBtls)
To Me accuracy antl ManplNnaN atlle IMOmratlM Meadows In this AUNorNXm Form and euNorks(e)tlN foregoing.
�ipned tl '0 2%h day of Aught .30 3r1 n n_
Sri
WITNESS:
Tam 0 Know
11679 rearmefwv1 raw,
Afn exams
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