Koster, Bridgette Piue VICMV Cemetery 8. Crematorium
Quaker Roaa
Queen5bury, ryy 12604
O(516) 745-4477 or (51 a) 745-4476
FUNERAL HOME: - 4p ^� O.mny s0, ,Jll(/" Y6 / ' ., RCTURN TIME. ^p1,t
RATE A TIME REMAINS ARRIVED AT CREMATORY.
NAME OFFUNERAL - �-�' � 4iogM DIRECTOR OR rve4gI5TERER RESIDENT oEl1VEgINO REMAINS.
NAME.
JJJ --- cnSEn
TYPE OF CONTAINER l ----
aEs<aL�< gPa 1 se-nsAE�� y PLACE OF DEATH;
EA11MAYeO WEIGHT OF REMAINS C CONTAINER
PLACEO IN HOLO: -- 4Fle--/65
PLACED IN REFRIO CATION: _
DATE OF CREMATION TIME STARTED. E )O14t7 - 9E0-
ME COMPLeT
PLACED IN/ N WHICH RETO _ g _9R qn... MOVED „ �
f}t�
A
RT
RETORT 1V -�1 R[Mw NJ WERE CO[MgTEO: ��
RETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MOREp TNgq�URS
FROM TIME Of ACCEPTED DELIVERY'
NOTE 'MATZO . -
4 nll GC. ne ry ]HE .'fAmnNLNiTHE Or TEE fn¢MAT OTy,
D.P.rN ml^rSi
INEW PORK Division Of DMSIONOFCEMETER1Ee
sTATF OF ome c mmema Pi
aPPDgrooll Cemeteries l aMb,wllingt,; ;
N.. m,M FN)4`wn25
Authorization for Cremation and Disposition
Tina IutlrorbatlonFam meet be COMPWo Omit slginl May m MINen a nmmne hrsrematlon.
pro: =2312o20 Molina, /Oil
Cremakry NarM:Pine view Ctemetorlum
AddreM.51 Quaker Road. Que bury NY 128" Phan: (518)145d 77
CREMATION AS AN MREVERBIaLE AMD FINAL PROCE88.
Galati on is ramea oft by peeing Pe remains or tin dettaeM aM Me mentor M1adatt the remNM into a ueTeton member show
my are notional to money M1eet and fame. TM Met eM Memo WII IndnM end comma ewryDIN eawpl M"Fed mMa1.
wM1kM1 an all away will M Nfl after command.
and.
FdlOnrg vemalon.Me enmatory will nice reasonable moos n nmmne all dNe remains and story ureteral M1wn the moral
Member, Wt same normal do®r and residue sell Bosh M 10 whin. Tn uamalpy will separate incideMBl and foreign war mal May
tin remains and Me 'hote al and foreign material tin M homes a As Myired try war Tree eremhed remains all M maManinlN
rylwlxl Into small piecae and placed Into a dwynatM ttatermorum. CrennlM nmalns geMnlN an WlearlvM untll rw
sink lregment Is recogniuble ae skaNtml tlaaus.
OPENING OF THE CONTAINER
TM c emanry may Only open Pe container holding Me uncremaNd human remains in limped u¢umMm ay,am as to confirm May
hmm nNemam ddw Wen sure Matnomealhic la reasednfiiM might lra employees hydroage of aamabryprophe M
M1ame rynuim en deYwrM lnaComalMrwtkM1 is no[euMEle forcnmMlon emM1 wceromonal ar nrrhl OekN.Ma
aemebry will nmforor tNnnmeinsairowed InfoaauMWc aworras and eawpb Nitnmal a ldi cwnind as
mnteirer ar Nit o-anakror removal of remains van bemnucnE Mtan a wM1ness eM ntn be dine in privan, wM dignity and reapxt
DENTIF CATION OF DEGEABED
Name of Dismissed: Bridgers Koster MeriW Slew: Never Marned
Last smash Moll 33 Queen Street, Whitehall, NY 12887
Plans 0meath, 33 Queen Street. WhlMhall. NY 128a7
sax: El ® F Ape-. 52 DON 1211I11%7 soft aoxM: Og/22/2020 EaWMfod lNphat
CeaaipMn anakeVmneirnr in wMh m mall ber s .
CorrugateE carclost . Matttlews Casket Company
PE ( NCOwho,or MSPOERION
IPuson(s)m mNN d deprsllvn. whar 0.NE d the ldbwiM)
I mails en tlw oWgnatel again of the ddxased dwig" W in a wall Or wmMn moment eyeaded puwumt to Public
Berom I201.
�l ' "
\IM/e eTe no anoWedge that Medeceased examad a wMten instrument pumam to Pubho Health Law SMion 4201 wa
wr br%nrxtl M for Me nycsltlm a his or her nmmne an Any are the penonno MNng on"under Public HMM low
SeMm 4201 an haw the Not 10 monm common of the remains 0Mae diamond Myrour M OnshlP to aM dews W M as
rolrow
aritlgette Koster
DOS-1888-I(way.O4R0) Page 1 of 3
Authorization for Cremation and Disposition
poetry year fee rd crow)
Number 4 oescrdvv Payment
1. A perscn deepened in wrung pearl Ptak KaWrh Law Section 4201(3):
x. TM su ring spouse;
L. Thesurv�'whg donesm pNrer.
s. Any surnoig dead chases yeare of pe«ogx;
4. A surv'wiy perem',
a. A summip abling eyhleen years 0 qe or older;
I A dwlly appoil publisher.
T. My panods)so htsen years of red or older entitled to ii in the estate and was yare correct In Masterard to the awarded.
B. A duty appointed Toll d Ma esbN:
9. A dove Mend or relative who has emoted a writes stekmem pu Quart W Public Heats law Section 4201(71;
1 ielw filourerM eownty or a Nord;admn iieralor it"i pursuant W the 5un m'c9es Court Prcetdure Act:
qny rperscn wMn adirq on to W Me dowased and who ere Moral a wooden ebtement pursuant W Public HeaM
law Session 4201(7).
TH EEofIMMetw4p)
e hxby affirm Met hey body of day dewutl deals set deal a benery, banery pal power sell,Mb Impart,
deutw and INI any such metenaX were removed sobro Me exearbn of area Aumwlas Fp , Fallun to remere
tlmeX o todnmvnon m.r roan m Nrm W tM dsmvhwr end compulsory pvmrrml.
_ Me Mrm Mp lnsbu omhava been More to CaB�sldy VoloSttatllna
regaMln9 Me moral M any Mantrap propel d other Miry a value soul any down v9nFg bakwm any barrel rmica oyMe
aced w'uhes to passers. Pine View Crematorium
IDk Mr Me removal of peRMel name hose Me mpainarar M1pn Me amelN dMaONmeb. Pensoml Mns MX In Ma
rorMe mnvine v.M by destroyed DY May mmetlwt processor and Cr my be Mdw mn etl aXer cvtlon
n .
neby auihoriw Pure Uew Crematorium
nsw.rurw Mdnmarotlw ramslm dMmdxuvetl.
TIQVAi
Ile heavy authorize the named NNpI Monday W pmvMa for delHery,to and cnmetlon by an al lmaW
cover aul X Matthews necessary In Me opinion of Me fora li rscar, and to umeM this Mom to provide the correct name and
Mdr deuCh aldmela cremerti
FINAL OIBMWQ
TM rearran anithormal to re¢M Me aemappol remdns Of Me comets rpm Me CWMSMT car
woe'.Fori Denny Staffound Furearal Home. Carl VonStetma
add ems 53 Cuaker Road, Cueenstpury, W 12804 )romrp (518) 702-1114
Tha appeared natural of dwsed way M d'upaxd of es homes:
Retum W family
If for any reran Me peadl amM above Mm M they psem dnspenrpN sent
Pine Viaw Crematorium Npahmf Wglve Posaetknd
m.ga. .w
Me remaimm Reg Denny StaRaN Funeral Home by actualm..ww..rmw
M Mrson aby rplvlaM mail. &Idgeae Koster
pOS19SS-t(Rev. 0d201 ra deal
Authorization for Cremation and Disposition
/ normal me rolrowng
I/\ x+en a Met vn.rem.n.ere not mimes wnnb izo do"acoastal
�� \ Pine Yaw Crematorium may alryae of Me remeimw
eels manner, wish as W coastal. nsw.wo.wan
ONFAIATON COWMNE0.
(sl ONE alare@Wnirg)
An on to he used as a coa hor Me cremm remains has been pumhaud from Regan Ninny SteRord Funeral
coal
am is described as hollows:
�{ Maltltlwum Nba emYlb M1BM saelmm<mn.rad rem01ns. 0neaidowns igia wMelmr cosy Fe used braNrvery
I cols nNyelpecAeeed lMbundsMeMonsoon um wlwrWssa oroMarw'm provieed
Pine Yaw Crematorum will place the unmans remain in
a No Nmporery mmeinew fcr sayyrv. m..✓o.rrre
1hns AUNwrhadom Form wn provided thy Capdy VOlSlelUne was evecuW at
Regan Denny SlaRmd Funeral Home
53 Quaker Road, Quadrat NY 121NX
and 'a agreed by the mnenl 6reaor as whinesmIts coal
Me haw rereivd a completed npy of this AUMorlast Fom,.
Tom INTonfsi Nand bebw Were Me Po19onfai In con"of did ionization,who by signing hills Association)Form,efterllaf
ads Me accuracy and wmplMrwes of Me Mfwmaddn contained! M Mot AUMwfaefbn Fam aM aufhwkeisi Me brpofng.
Slashed MN 23rd days September Shirley Maw ) JYl"`�`u" 1 K
m. vww
33 Queen SYreet, Whitehall, NY 128E1-
Snake
.maew. e,a w,aa
Abhee
WRNE88:
Cassidy VonStaMna
re+rlo.e.vonsex.w
131d9
Bricaelte l(oster
w.wasm
OOS-lE (are,hall Pop 3 of