Krywy, Donald Pine View Cemetery 8, Crematorium
Quaker Road
Queensbury, NY -12804
(518) 74 5-4477 or (516) 745-4476
FUNERAL HOME:
b(ASSZ On
RETURN TIME:
DATE 6 TIME REMAINS AINS ARRIVED AT CRLMAI ()RY: Q
��I�Ip Z:WI�
NAME OF FUNERAL nlTiEc FOR OR rtecrzl�• ....---.....---•---_..._._.._-----...................
,TCRED RESIDENT DELIVERING R[rvIAINS.
MIL µAe
KS NPA
.............. .........
NAME:
LASE it //S3
TYPE Or CONTAINER: ....._
PLACE OF - _..T......._i"°�
DEATH: S Z. 1�� ci �.5�'_....
ESTIMATED WEIGH F- OF
............
REMAINS 8. CONTAINER
PLACED IN
l60 it US(7c.
HOLD: -...__.
_
PLACED IN REFRIGERATION;
z,3of 11
DATE OF CREMATION:
TIME STARTED: ��
Ail I _—
_._. ..._ "T-IME. COMPLETED:
PLACED IN RE'rof T _._.
_.._... _.. All _..MOVED:
RETORT (I IN WHICH REMAINS WERE CRLMAIEU:
DETAILED REASON FOR BELAY IF REMAINS WErtu CREMATED MORE7�
FROM TIME OF ACCEPTED DELIVERY: THAN qp HOURS
NOTE: THti . _
.............
ItIMA I ION ._..__._....___
LOG SHl1E.1. I1C lit: 1AINED IN INE PEItM/ NENT rILE or THC CILEMnfoRy.
n
Department of Stafo
JJ" EWYORK Division of DIVISION OF CEMETERIES
STATE OF
OPPORTUNITY.
Cemeteries
•
Authorization for Cremation and Disposition
This Authonzarion Form must be completed and signed prior to delivery of remains for cremation
10/22/2020 C-3
Pine View Crematory
21 Quaker Road. Queensbury. 12804 , (518) 745-4477
CREMATION ES AN IRREVERSIBLE AND FINAL PROCESS
the'; eros sjoiectee*c. gee: The heat and flame will incinerate and consume everything except bone and metal.
which are all that will be left after cremation.
the e e s ••••,..: • •-•ie crep—at.,:p
the -s-e!--si ano 7fle pe• 3-7 .
c.,;,ef;zec aced eies..-joeced Cremated remains generally are pulverized until no
single fragment is recognizable as skeletal tissue
OPENING OF THE CONTAINER
T^eo r C sce'- 9 e- ' --s-e•-"es - s:s
toe sieceasec 7_ e-s•...•e It
human remains are delivered in a container which is not suitable for cremation such as ceremonial or rental casket. the
crematory will require that the remains be moved into a suitable container before it accepts the remains The ccenin.g of a
-e- esss.e• _?. ,vOEfsr"r s es IDENTIFICATION OF OF DECEASED
Donald Krywy Divorced
Name D'Decee,sec
52 Division Street, Ballston Spa. NY 12020
52 Division Street. Ballston Spa. NY 12020
se •• D v69 07/09/1949 10/21/2020 meo 7(90.
- E.--..-=1""L':; •
Florence Casket Company (Cardboard Box w/wooden Base)
PERSON IN CONTROL OF DISPOSiTioN
a, •
_
.7-
Sec`, • a-7 • --- Ps esse:es.-: Nly/Our reiationship TO the deceased is as
follows
Donald Krywy
Authorization for Cremation and Disposition
Lara Ashley(Daughter)
2a.
4
8.
9. 7s,Se =
cc.
•=,...E arc -; .2' _ 7: A tit norization Forin Failure to remove
these items prior to cremation may result in harm to the crematory and crematory personnel
Rolland G. Hoag
C. tne 2‘ g
Pine View Crematory
Personal items left in the
container or with the remains will be destroyed by the cremation process and cannot be retrieved after cremation
Pine View Crematory
/We hereby authorize
to cremate the remains of the deceased.
9,177:
I/we hereby atitnorize the named funeral director to provide for deLyery to ana cremation by an alterrate
crematory, if deemed necessary in the opir,ionu ole Funeral director. and to amend this form to provide the correct name and
address of such alternate crematory
FINAL DISPOSITION
Compassionate Funeral Care
_402 Maple Ave.. Saratoga Springs, NY 12866 p (518)584-4844
-• - - - - - -
St. Peters Cemetery
Pine View Crematory
Compassionate Funeral Care. Inc
Donald Krywy
Authonzation for Cremation and Disposition
RMATON CONFiVNERILJR,'.q.
•
uthor;zotic,r. Form
;.-,
. 2 :1 ortrIF •Authcr,_•_attort Form
pc,sorts)identified below,s.*.ye the bersootc) n 000t70. c)4 chsp3sition, who by sign:rig this Auttorizat:on
tt or
the accuracy c',,,rnplete,,2s,or the•nt";-.,rmatIon c.,-orta'ned+n thrsA:ithonzatron Farm and auth3rize(ss titr:
signed this relay of -
7 ,
•
&La-7-A t--7-k--)k AtAN-k4ST ICP1-4 C.33C:)-st,11
.
•
N._
11LO'C‘E _
_ _ -