Waldron, Ronald Edward Pine View Cemetery & Crematorium
Quaker Noad
Queerisburyl NY 12604
(518) 745-4477 or (510) 745-4476
FUNERAL HOME: _ - n8 Vryl
RETURN TIME
DATE & TIME REMAINS ARRIVED Al CREMATONY'. _
NAME OF FUNERAL DIREc TOR OR REGRISTERED RESIDENT DELIVERING REMAIN
Tin
NAME _ . . BWIALp UALDeOp
415I(E tlJ_ ..low
TYPE OF CONTAINER q-_ N C-o'L✓x.� � _ptIYD
PLACE OF DEATH l5 /1 (F IN
at)
ESTIMATED WEIGHT OF REMAINS & CONTAINER
PLACES IN HOLD: �C -
PLACED IN RCFRI E! AT ON _
DATE OF CREMATIO -- iT✓o?n - - -
_.
TIME STARTED 13sgr7 TIMEc 3�00
PLACED IN RETORT ( yaQh
..MOVED 2.(CPI1� ypi4
RETORT II IN WHICH REMAINS WERE CREMATED:
DETAILED REASON FOR O -D Ais - --'DELAY IF REMAINS WERE CREMgTEMORE THAN yD HOURS
PRINTING Or ACCEPTED DELIVERY'
"OTRT"aCRMATION LOG 314ut Or, x O m
-
mEMHI T14 LE Or nIE Cn Emnmpv,
rk mark
Imeram ino
STaA r VORK Division of DIVI61Dx DFCExE.EaIEF
REO Cwnmp[e Pbu
°FP FORTUNM_ Cemeteries 09^pey12 °i°°0•
salary 23hal
I5rx«.aee
anrMp^
Authorization for Cremation and Disposition
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auddrum 21 Quaker Roed.o�rv. NV 131101 Fde m.. 5167464477
CgIY.TON IS AN IRflP/IM YEp FWKChastain a marks aut fork,waft ft emem,Ed VIVO FROCOI. _
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IDENTIFICATION OF D6CEASEO
xem.al D.w.na. Ror rw,.m MISIM M.aW 9mNe'. Diwlae
lal Known AEaneee ap acoe$hall M 3i Fon Am. xr IMQ
Pl. dC •pG S Apt 3, FonAm.W 12W
65 - 11/13I195d Oee.do..mw+arzopo Fmnmae v.W¢ 180
was ENE OF rs.._ DDa
Cee[n nd[NecmllNnrm MeN rwrlam ei.be,
bllwW.
Minimum CM=Wn Gapkel Floralece Caekae Go. Celdt»mLLPine
prinfrion.or eposnlox
91 3L;5[anmu d aesu o,.I 4VE Oa'E a he Oaks Marc?)
I mMb ere are aot9n.lea mend of the avadeef de nI In.khm or xlibn Lubumnl@u summer Ed pWu.
X0Nll{�M}�Ilan Sedlon 4201.
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e egaifan nermr9lxreemmep M(S)a prknly ulcer PudkM®NrIx
SKMnApp+ xm lmwme adnmma�armeom.aa,dm.mnar,.daa "__ ,. IN,Tprm.mmmpmm.a.[a.exo
Ronald Edward Waldron
P.p. + d9
DDs1Kaf Iaev.out01
Authorization for Cremation and Disposition
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u ilm wrvmnp dnwe4c Penner
]. Any elwirq elyN epAben yem W age or obe,
A ANnWFpp
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8 A M1uIry ryPoyIW 0ili
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S. A day sarminmd Mum"q the mtm
R. A tl9e band oe Natlre who has amant a when elaRnlmt pursuant to Pai Hat lsw St aml i]Y
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PRIM. Am Mmr gmern Whoe.Gng on lNun ut the h aeeo aM Who has aaeokM a wYYn alabment pu' UP PUMP NaNh
Law Section 4Ot11).
(f ALL That a Me ldbMnp)
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w xoioamre nenm aM that anyauq,mmemem were irmowU Prim sylkn NNa AubmeoYen Fame FaYnbnmow
IrNthat Xe eyiabetmeatlen may resuN In M1emrb MetmnabtyaM ctawebry[amm�M.
li aam Pat M�e had Men gi to MorpanlMCn
mamma MeMaine of my Panama oran.awroa.w.wuNl.m Lw+om egNrw eso.r or.rv1Ynw n.tsaMa
EeWesM vnNeeWOrMenC. Pine Lowe Crtmabry
n nq reyonude br Ma remwel otgmnal ibma Iemn Me rundircr cr hpn therwnmm oI1M0BUate]. Penonel lbmF M11n tlm
w WM Me nmtlw wllMombnyeJ ayW mnaUan prwaea enJ unM Ce nlMaaabrcmmetlon.
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b amnab me mmalnd W tlecNeeE.
ILL OPTIOWL)
Mem Mandy auMwNze Ma name l Immml aMcmrb pmr10.M ENlmry No Me cmmatlom ay an albmY
Mabry.Ntlam" rtmaaury In the open ion Nme Nneal d weer.and b amend NM b/m M prorlma Me CemR name aM
addmm 05wom eMmab camebry.
FN!L DISPOSVION
the Pont outint to mmiwtle memaked ni Of Me deed mwn tla vem k.
NaMR Rini m, Fusel Nmre
AM�y. V amadMy FM Edwaml NY 12VB rs 516]0]-9$69
the Frem t mm dM1>IdaY WO b tY>toW of a me
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it ran Wei me mmm nerN dew era MYa ueWatd mneta.
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M PRI
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Authorlatim for Cremation and DisfaIcaghion
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