Ovitt, Caroline Pine View Cemetery & Crematorium
Quaker Roacl
Queensburyl NY 12804
(518) 745-4477 or (SI8) 745-4476
FUNERAL HOME: _Zwsz�
-- _ RETURN TIME:
DATE & TIME REM4INGARRIVED AT CR[mgiURY; .
NAME OF FUNERAL OIREC'fOR OR REGRISTERBD RESIDENT DELIVERING REMAINS:
li MgING;
NAME ._..__..__. -
TYPE OF CONTAINER, CASEn 1 1fti -- -'
lle../.( 4A1•a cre»r./,aF ! f.nn..ielk:.z✓__
PLACE OF DEATH: �/qn �r I/ J r�// // /' V ......
CSTIMATEO WEIGHT OF REMAINS M CONTA NCR /00
l6s _s.iR,( 9sip�t
PLgceD IN HOLD: ----
PLACED IN REFRIGERATION:
DATE Of
CREMATION:
TIME STARTED; __ /U 'CTpn nME COMPLETEG
PLACED IN RETORT a2TAR _ . , MOVED
RETORT II IN WHICH REMAINS WERE CI1CMpTFD;
OEipILEO REASON FOR OELpTIi REMAINS W[NE CRCMATEO MORE THAN
FROM TIME OF ACCEPTED OCLIVERY; 40 HOURS
NOTE. MATIO
LOG qLL aen NTR E AExm Nevi r I< or . IE ex EMAron..
Pro,Yak gas,
O memoswe
NEW VORK Division of Dw61p1OFCEMEFERl6
0FvoR°IUxITr. sD re5,^merceVeuua
Cemeteries Al m„,;,3,adot
Te,eplwne'.(CMPsab]36
Now Ws rya,
Authorisation for Cremation and Disposition
This AuMori "O Form must Ce completed and signed prior 0 delivery of remains Mrcmnatlon.
Date:9/25/2020 Number: /A!J
Carol rvema. Pine View Crematory
Quaker Reed.Ourenal NY 13001 516715M77
Andrew: PM1one:
CREMATION 13 AN IRREVERs1elE AND FINAL PROCE%.
Cremation is car col by pktln0 the remains of Me Miami and Me Personal molding Me remains Into a annual chamberwMn
Meyereaublmdedtc MteneenwlaNflame. TMM1 Land Mmewill InGnewe and Canwme werytheng exupt Eons am metal,
which are all Met will be singer mmatlon.
FotlMini cremation the cremume,will rake reasonable Mode to remme all al remains and either Town hom the uemeNn
chamber big some minimal dust and moral mill likely be Ito bahiM. The crernal will separele Inti ntal and usage counsel kph
n1 wed into smeal and all ncidental tlnega maeemproll d comeeddWas req M� dmmai e0enenll empulwlaw l„wdualm M
singly,
recognizable
eas swlo Ides arum
single rnemerrc is recoOnlvhle.a al®Ietam daeua.
OPENING OF THE CONTAINER
The crematory may only min the danl&ner holding the urzoo maled human remains In lM2N 0rormslanl such as to MMM the
assembly of the dericashossed p to broad that eO mateel is enclosed which might PrOne empoyeea 0r damage the crematory pmpeq, V
human nmams am bsrrverW in a convener winch Is not suitable for cremation such its commerce or renal mdi Me
mmory win "firm Met Me mnaie be moved Into a suitable containerm e r adds it real Me nai . me Opening Ma
Pool or Me hacker or removal of annual be mnduced before a wdmew and will be doe in phrase, unto dignify and rwpecl.
IDENTIFICATION OFDEC ED
Caroline Onrimnm Mvew Stoms. Widowed
Name a DecMmAI.
Last agent Lbtl + h11 Rd ell/ nN IZ835
Pace moeMn:
Glens Falls Hospital, Glen Fells, NY 12901
sex: OM MF Age: a DON' 2/5/1923 Code a Assn 9f25f2020 eadnmked wagm: (�
Description a Cmkeuantemer M whit mmaM sell be directed.
McDonald basic cremation container, no interior
( s rtON
Pemm(al ins ronna or Papwil energy UNC cello examined
I amNJe are the addressed agent of Ma demadd designated m a will awes,instrument exaulad purwea b Pun ie
Hamm Law becan 4201.
a OR-
Fb� IMN M1ere no knowledge that the deWBsed executed ewMbninYmmeni punuam lO Public HeeNn Law Section 02010ra
II Containing dvechme for the mspoaiti0n o1 his or her remains ant And are Me Ma (s) raving pdonN under Pudic mulch taw
samon 0201 and M1we Me ngnt to aullorize cremaan of Me remains a Me tlxaesbd. *10ur dmaaoenlp b Me demised h as
believes: Caroline GNSI
DOS 181(Rev. 08115) Page 1 of 3
dtHhorization for Cremation and Disposition
bnggMe bWw.ng)
x�two undestrand Mat If the ensure are not claimed earn 120 data amemati ss
Pine New centenary
may dimpose d the remains in
an nreNarabb manner smt as 4a®nening �
CREMATION CONTAINERIIIRN
(IrvtiaI ONEMMa wArnmef
An um W be used as a container for re featured remahw has been puNueadmom
and is desmbe l As Vicinity
]Me understand tlut Ifthe um la wo Nnall to had the eMre vemabd remains, an addNmal nine consumer may be used for delivery,
ore.
An um Is M yet purchases IMK standard Mat Nno um p rur AssM or answered Waisted
Pine view cmmawry
Mil Near the NatWest remains in
m.7nnf
a red temryneir container for delivery,
Patricia Miller
Thin AUlMrtretlm Form was Prwged ly wed execWdan
Brewer Funeral Home, Inc.
N Church St. t Imeme NY 12818 Iwmvxw ra'I
and is snored by me meal director as waeu W N veution �h
Miss have re¢Iued a carter red copy of his Audermadw Form.
The Ponoms)Idx fisd below Were to panoints)inimnbol Wch aseeltion, who 4 signing this Authorization Form, 2t 43 i
M me accuracy and combwu mma of ew IMomaNm conMimd In this AUMaixatlm Form and statements)The Nassau her
Signed this 25 it September m 20
Charles Ovid
Sri
Jesse
.ww>,..a.w. a.m.
M WITNESS:
TNEe Miller12465
`'T(1�A_YIA�A(T_N'a1
nadvmaaw.w m�srm�4.e�
ne
Carolina Ovid
DOS1891 gays. Who Page 3 of
Aidthorlagg a for Cremation and position �
ltnaertmxn Me se name)
Humber'. 3 oaamptmn: son
V. A aDn_designated in wltlino P=uOMb Pueiia Health LanesM'pn{2oi(31:
a. The surviving mom&m mummer;
3. Any s rill chid agmern yeah of age Or older,
M S. AsumWno aiom
S. Alavfull ned grewhgh� VeaB olaoe or older
vawomheeeuabotero
a.7. Adutty appobilee factory MMfgaeta@.oiaer entitled lo sham in ma n161e and wno ierere aoa6elmreiationampm me ErXaEN;
Y A chase Mme or relative Wm has executed a worker sbtemwt Pursuant o Puam Health law Secrend2o1(n;
10. AMief fill ol!r of a county or a Public administrator apparel Pursuant o the sunogab a Co um Rwxeure Act
Hall. Any At person who 19 atone On Memo of dseasm and ANY has executed a almbmem pursuant m Puam Haann
laar secdon 4201M
UsedAlf yHREE ariar wM)
_l6L i healthy afirm mat Me GMy of the da¢ased Ecea not contain a berry Maury mill, Parer All. r mdwe impl.nt.
IX raeiarbse dinew and that any such materials ware removed panda Me exaCudon Of the APMw "M Form, FellumWB ow
IMsa Items Priam cremaaph may mulct In al ma and cnmamry and ammMry particulate,
e�2VA6 aMrm NmiowWt9ona Mve Been Parem Miller
drama m
rryemine Me lOf any ceranlwo Or offer Nine Of value when any pereal signing Mlcw or any family member of the
aneeaee MaMempreeerve. Pare was cmmaday
ix Act reapon.iek War Ne removal Mparaanal ilema M1om Me cOMainer samurai
Pm OnMMg pomwgt $"in Ma
a inworw anmamawinnede W"ay Meusmaaen ProoNsandaannWMrMaeaflafter Cramallon
6 .
/� �L V//e MBby.umo ' ew Pint N Cremator y
J
w vent
m amab the remains OI the yAaaed,
Emliumeasi
The person eNlwn:em to rereive Me chummed rerrams Of Me eeceuW from she aemNory'u:
emver Funeral Home Inc.
Name'
Address'. 20 CM1UM St, kale Wremu, M' 12Ge 518 27M
Plme:
ine aemamd remains M ee Wsell the dim aas plbas:
Retuned to Charles
If her any men the prewar added a time cot bb pcanavion as the uwnelee remains,
Prev Contrary
arewx Full Home,Inrw~ is auNcez�to give Possession of
Me remernsm rrvwavNi eyeedvery
in nerdy hryiereadmil.
Caroline Ovia
WSl aebf(Rev. M/i5) m...areaa Page 2 of