Bigelow, Christopher J. PIT O ViCVV Cemetery $ Crematorium
QOaker Road
Queensburyl NY 12804
(S T 8) 745-4477 Or (s t 0) 745-4476
FUNERAL HOME: - . nb ruAta.
DATE 8 TIM - - -- - ---'" ' RETURN TIME
E REMAINS ARRIVED AT CRtMA TURY:
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT UELIVEgING REMAINS,.
NAME: CNW -. _..
- ._ ._ jswP1!¢R 8t6w''4`u _ --
TYPE OF CONTAINER F(FK4 C1W CASE roLT�
PLACE OF DEATH: U/ C/OS . NR,i-/ r[// i_ 1` tt _
ESTIMATED WEIGHT OF REMAINS g CONTAINER U 1
PLACED IN HOLD: --- `00 -ar _
PLACED IN REFFM GERATION.
roomy
DATE OF CREMATION
TIME STARTED:
._ -" ' - � (lE)tp
_
.- 7Il 1
PLACED IN RETORT �7M q MOVED
y� TIME co R
p ayl�
RETORT I/ IN WHIC 7 XX REMAINS WERE CREMATED:
DETAILEO REASON FOR p ELAY IF 6
REMAINS P"M C CREMATED MORE THAN VB FROM TIME OF ACCEPTED DCLIVFRY' HOURS
NOTE. TIME CRbMAMOrvt _. . .
aMY,Y11k SYle
OBpaF CEM fS ES
ST YORK Division of °MSpH OF LEMETER1Es
STATEOF
° Cemeteries as ;n'��"H::
ny.NY 12231r
iNeri bilBHR6R6
Authorization for Cremation and Disposition
This Augar4 m False must he completed and signed martami&A inm Noncriminal
Wte Septmhr23,2020 Number. 1054
Crematory Name Piney CremTCry
Address:210ueko Road Queensberry, New Years: 12804 Phone: b9-TGSaYTr
CREMATION 18 AN IRREVERSIBLE AND FINAL PROCESS.
Crawl armed old by plating the remains of me deceased and the dammer holding the remains into a summer chamber where
theyaresubj6Ndbinlersehealandfame. The hem ant name will lnct"u and consumer BveryMing except bone and metal,
which are all tlnt will tea Ind after cmnvtmn.
Following weal'm,the Daman will tab resonances eflMslo mT all ofthe remains and far mabdel ban the aematw
Member, bid some minimal dust and residue will likely W let behind. The tamer ry vdll separate madeMal and hall museum Par
the remains and the endorsed and Real maloiel will be usual Was required by law. Theaematedremainsmilbem anirelly
pulverised trite small pieUs and placed Into a designated consumer or um. Cremated mmains gently are pulwN d until rW
$trials rre9maM is Missouri as aPNNaI memo
OPENING OF THE CONTAINER
The crematory may only open the combiner hoseng the unoemaled human small limited encumbrances.such as to Wnnrm the
identity of the deceased or N ensure that no matMial I8 enclosed which might injureempoyrm,or damage the crematory propider N
human remains are dGllwred In a cmlain"wMch Is rid suitable for cremadan Such as commit or small Gaket,the
mmeter wile transfer Oarenm rre ' n'al of memm y ASK be accounted before a witness and w11Sbe And"inedn aft vacy�'a di ry and nel
a n o spea.
IDENTIFICATION OF DECEASED
Name W Deceased Christopher J.Soalow Mar l SMWs: Nwer Merced
Lest Known Address: 3829 West Cmk Rd, Bahama, W05733
Played Of Want: Glens Falls Center
Few: El 13F Age: WYs DOB 00613011954 Dab of Death W-23-2020 EMimsled Vil 400
Dispersion of®skeVcmtairorm winch remind wnl he defwered.
Florence Casket, plywood corrugated cardboard container.
PERSON N C°XTROL OF D SP°srtpX
(Porsm(s) in cmlMoldapavTim, inifiel ONE of the/showing)
I aiMNe are the designated startof the dBceBaed dawgnabd in a well or wham imb M eaeMed pursuant t0 Fred
Health Law System 0201.
0
INue have no knowledge that the dBIXased eaem"a anden instrument pursuant to Public Health Law Sesim 201 Or a
ill wnta dneciionSfor the dispai M him or Mr remains and flue MY,they permal having Perry under Public Health Lew
Section 4201 and have the right to authorize cremabon oft"remains of the recommend. MylOm MVOoneM1lpto Me MceeaN ie ae
stets
Christopher J. Bigelow
DOS-1 Si(Rev. her Page 1 of 3
Authorization for Cremation anti Disposition
fi m dhorn the fiat bed ay
Numbers oe¢vlpticn'. A¢u"Nire sibling ei2Meen y mNege or older.
1. 7nPorsm designated in unbng pur¢uoM to PLi Health Lax Section 4201 WI);
2.a. The snmM am ne a surriet ei paree¢,
3. Any aurwing cliif egMeen Years M ye or olEer',
<. AmrYnng parent;
S. AsuMring abbrg eghteen years of age or older',
8. A livart mounts] guaMpn;
T. Any psmon(s)eigMeen years of Age m okbrengled W sham In Me estate and who iyam doses in relNWvhip he Metl[¢ueP,
8. A duty appointed Well of the estate
9. Aclose fraud or remhe Who meexwu awinter NWMment Pursuant amiken 4201(7)
10. A U'ml finial oficer of a C[u IcentrPublic Heath Lan Counrea
100. Airy MM1er person Who asadiing cr apuMlcadminiambappoin who
pur¢uanitada the wharmstt Court PrmWve Av1',
Law SerAon 4201 p(. adding pefwlloltM deceased end wM1a las eveMedewMbn statement punueMb Pubic Heath
( LTHREEWIM ddAdm )
IMas hereby a"Mat the body MMe d ased doe¢nd contain a hatlery, batlery, pack, payer nil, mdvceNNe implant,
Or Md'paNive device and that any such materula were removed ryidb Me execub[n Nths AUMwIIDYm Form. Fvlum t[rymave
• glorm[ramatlon Try molt in harm b Me cremamry entl Cmnatory pmannN.
Ads,alfim Mat insM1ugims;have been given No front Mummy
rearding Me remoml of any personal�or Other thing N value wmM arty Wr Arguing below her any body memo of Ma
deceaseywimhestopreserve. Pne Yaw Cremaory
is herOmpanslblefor the remwel of personal items from the mntamerw from the remmns of Me ceseased. %mmvllbmelMin Ma
Awith Me remains will be deeb[yed Ey tly crematlon pr[uva and wnmt be Mmount after rnmadm.
IWe haunt authonu Plea view Crematory
((//�' "" rCni vywnr mcx a%Me mmafne of New tleuvwd.
olWW OPTIONAL)
their hereby whomit,Me named fuMrn ONmotor 0 provide far danvarr,b and cnmaum by an alb M
abry. if deemW nec III in the optfulle bn of Me lrector, and to am and Wild form W Powide Me[omd name and
Address of aibmate colnel
FINAL OISPoS T ON
The Penan aNlmxM W mcalwn the Cremated Named of the detea¢p from Me channel is'.
Name: M. B. Kilmer Fumral Home
AMess. 139 Man St Soul Ghana Fel¢, New York 121103 PMne. 518 lWil16
The u mMt remain¢W denuee wul be dispa W av!thaws'.
If Wor any reason the wean named abWe does mt fay pal wedMetlmatw rehi
Pine View Carol bwNi Id ewe Pa¢ Ono
ro w
the remain¢ro M. B. pima'Fw.eral Horre by tlalrvery
In person orb w m.n
r regeMrea mad. Ch cn�Pn.rd.Bgalmv
DOS-10994(Rev.0I20) Iw++m
Ppe2 al3
Authorization for Cremation and Disposition
/���fj�J�}�Mrye rdrownrg�
A/ Ii understand Mal if iM rtmalna eR not claimed value 120 days a Corrosion,
I/ Pine Vlex Comebry
Awemay dispose of Me remama In
an mentionable msnrer, won as by wonde rig.
CREWTIONCONTNNEMRN
(ICI ONE 0 day bWwMpf
An um to be used as a consumer lm IN Pemaled remain¢has been puMesM from M. B. oter Funnel Home
and is whomm ed as follds,'.
more unde9und that if IM um Is Ise amyl 10 had Me more vdnelN remains,an sensorial ym Wmalrbr may be ueN M dakmy.
0
Ao um bl na yst purchased. IA\e undemend Mal rcno um Is ynchaaed oromeiwise prwided
Pine View Cnmalay will plate the Instals] remains in
a rigid tempomry wnF"ner for dNivery. na*exurnau�
This AUBwnudm some was provided by Timothy Murphy urea swooned in
M B. enter Fun mil Nmre ✓'^'^"u'k'°rrve,ai
1W Mein 31.5oNh Glans Falls. hex York 130W r...rraw..x...
mA u signed by the Noted director as vat o its execuron.
WJa Nye ressived a man tri ed copy of this McNcrosa icn Form.
The penonpl identified below Wan Me penonp)in wrier of chposNon,who by signing able AUMMaation Form, atlesgs)
to"accunry and compbbnwe ofrawNomination contained in this An handwritten and rate
tole
3ignW tole 33 dey of September m f0
Burs Bigelow 1
3839 ANA Creek Rd Bandon.VT 0 733
wungeraw—
onwarr -weans
WTNE%:
Tmdhy Murphy
iArovovu ariremerrw,..i r �a,ws,v.rv..
1259T
Chdske tat J. MINOW
DOB-18W(Ray. 014tJ) Page 3 a 3