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Huffer, judith A 7 L t01.y 6 L t•C. IYI:ItOt'iUrl'T Q"•, k(:'t I<0 ,-,1(1 Qu(..'(>I1si)u1Y1 NY '1230‹) ( J 1 3 ) -/45-<14 / */ Or ( `—1 (I) 71 5 1UNrrznE ►taN,( ; 1(u4k2 t, 2 YlM(: 12C: I2t::TURN MiLlnl:, Ar ltl TIMI pnr Vl0 A r.ttisrvin NAME or f�UNf� pl( Y • �/1 7=RAl. rrrtr°C IOr l'P/ /G 0 t hrr rt1-(;ItI;; Tl:`rtr'I.) I . . 1f . ft_�.Itl,:int 1. t� _ ........... .. Kul �C-IVliiltvCi ((r NAME; truprill kaFftt TYPE OrCOW,' nlNt::l'r: CA�� rr 5-6 414 PLACE OF ul=Al tt; - 1 - 1d0ad 1piand(,iPiccit Ict1e41 tirim n','I.L) wCl C't't l U1 Itl_MAINS ..._ Lit CONTAIN (IQ Z�3tS PLACED IN ftrr- RlGLit'tn ,'IUN; ()AlE 0r CR(.MATION: ... 1iJz _ . I TIME START 'i-I IVI I' 1�.U M I�( r.. 1 r'1.1. ...// ,)///���1�_{{{. I�LAcci) Iry NI l'c>rt t.; / / . �V/�J// l�<D�� _ . r ''v 1 Irti ltrTQrT', ii IN Wt1I MOVI;O; . .p:t(o a Ct-I Hl''MAiNs wl.:llf: C.I(l_MA fl:0: II 1j . DETAILED I?LA.iC)N 1=n12 f .... �I:.LAY IT 121:Mnin/ ; WI'Itl:: UI(LMA T (:f) MoRe T1.1 DRUM rIM(i Ur n(; C: C.111f;U 0 I- 1.IVL'.IlY THAN CIO IIpIJR ti NOTE. _... Tlll'. CIILnq/\ 1'IC)(y LSHALL - . LOG SIInI.I. III. rl I', InI1J.E.I) Iry III I: 1'I If MIl nl r,;Nl' r11.f: 01 TIi f. t:ll r:nn iNrUrty ...- • iVedr York State NEWYORK Depbriraent of State • o�wo Ti,Ntrr. [ 1'Vr15iort of •:IMSIaN aF'CEMETEffigS One'6.cmmerc4 Plaxa errteteries 99Washingt�rrAyanue . Aibaly:NY 1222 i-boot `trite ptroiie:fsitn-riee226:. . .: www dos ny.ggv Authorization tor.Cremation and SSSpositu n :• • This Authorization Form.rtmuet be.compieted and'signed prlerto deliirgry,of romaina.for cremation. Data:Jar-leery 13,2021. Nut„bee. Crematory Name, Pine View Ciernaty Address 21 Quaker Road,Qu©ensbury,NY'12f5'03 --- 518-745-4477 _ Phone: CREMATION r$AN IRREVERSIBLE AND FINAL,PROCESS. Cremation Es carried out by placing the remeine of the deceased end the container roldng it:te rema!r:r into a erernneon charlber where! they are abbiected to intense heat argil flame, The heat and flame wilt incinerate And cieni3ume overythIng.exeipt bone arid metat,j which are all that will be Left after cremation.' • . Following crernaricri,the crematory,will take reasonable etrorts to:eimove aN of the remains and:other Mate •rial . i chamber, but'some minirlal dust anc residue'wilt likely be left behind.' The cretrato will identastl{risen Lai n matc material the remains and the incidental end foreign material Will ce disdcsed of as regt.ired byleW..Then reina d remains'feOff Ibe:hiethar.isolly I pulverized into email pieces and placed tote a oes;rgnated Coritainer or urn, Cremated remitir e.generatiy ere pu(ratiked until-no single fragment is recoijrilzabia atr ekeietal tissue i oPENINO OF ie cohrtAmEH . . --- .�----: The crematory may only open the ccntainel holding the un-Crerlaied hunter remmna.in'irnrtectbricumstdnces such as to confirm the • identity of the decesrsec or to ensure that nc material is enclosed Which might injure arnpioyeae.or.dartteigethe r rernatory proPenty, It human remains are delivered In a container which is not suitable for cremation such as:ceremnrriai er'rentat casket,the crematory will require that the remains lee moved into a suitable Container before It accapte.the remains. The warring of a container or it1H transfer Or reimoval or routa re wig be conducted ba`4re a�vitnees and will be'clone in privacy,with;dignity anal respect. IDENTIFICATION OF DECEASED Name of Peaeaed:Judith A.Huffer „ _ • r� Marital Steider.. ort ed: • t..eat Known Address: 'i l K'C+ " - y L ' . .f.} acme cr Beath Y fi Se;r_' ©ivt i F A.ge! 74 0CE3, 12/28/1946 Date of tenth.9 1 11 3/2 02 1` 150 Estimated Wekght: Cescrirtjon o;c eket/containrd in hhicti r©rnpyina will be delivered. Minimum Cremation Casket, Florence Casket Co. Cardboard/Pine • PE SQlrt IN CONTROL OF DISPOSITION iPers,in(s!In contro ofi disposition., tie!0AIE of ttnU rati013:69) • - I emiliVa are the.designated agent of the dedeeeed designated in a will or',aritien instruntent exe,cut o pursuant to Public hisatth.Lew Section 4201; : OR • f� S"� • .-_._ i/Ala have no knowledge mat he deoeabed t xe-uted a written n iiiedi.slant pu�yant to Public Hearth Law Section will containing di ect�or for the oispos tir}n o,-tie or her remains and iiwe are.the err'.' r e hav inHe 4L1]'l Sir a .. ' ps Vert 1 91e k n under Publicedcoaee Law follows. sA', NtylOur relationship iu the deceaseyd is aiA Section 4:C� and'iSve tnE,•' ht to authorize r•rernarlon�`the same nc of the deo�a ., Judith A. Huffer. • 0.,,,.cvexcv and • • DOS 898-f(Ser.O410 Page 1 of 3, • Authorization for Cremation and Disposition {Insert from the.(wt blow) " �.---- lvlerlxrar 5 t�eSGtptlUn: Surviving sib eighteen years of ale ar b dot _ ling— 1. A person desigrratec.in wrltlrie pursuant to Pubic Health Law Seetien 4201 t3); 2. The surviving 9 Douse: • :,; 2a- The surviving domestic partrer; 3. Any surviving chird,eighteert years of ego cr altirar; 4. AservIvingparent; • • 5. • 4 surAving siblirg ei;ehtraen;'ears of•ac r or,okeer, 6. A lawfully appointee guardian: 7. Any persons)eighteen years of age or order entitied.toshene in the estMM and wei lieate,ciosest.in relaticnshiptc the deceased; 8. duly appointed fiduciary of the estate; 8. A close friend or relative who has exacted a v,citten statement p rsuar t to Public Heath.Law Section 4201(T), 10. A chief fiscal officer of a county cr a public senenistrator apPolnted pursuarlt to;Inc Surragste's:'ourt Procedure Act lea, Any other person who is,acting on behalf Of the deceased and wtxs has executed a written statement pursjjentto Public Health Law Section d..01(7). {!ri r!ALL MIRE-6 of the fc,'lowdn!3) y� +f"rtf+Ne netgby affirm that the body of the deceased doss not cd eain a battery pet. teiy:.p k,.pov r:ee, rgdioartive implant, or radioactive device and that any such mater'aiseeere removed p„orto the•eirecutityri o1 this Autharisarlorf Form Fabure to remove these items prior to cremation may reouft hiharm to the crematory aiid'erermtory pereotinel. �rai:u S"81,�ve affirm that instructions have even given to 3tephenie A Gilman ti • regarding the removal of anyy personal i properly?r other of vplu9 Yuh'sc�i•dny peravri sigrrlrrg tse•�ow or zny tairti#y menever:of the �decenased wiene to preserve. Pine View Cremator s not responsible for ihe removal of parsonel items from,the container or train:the erns ns of the de ceased. Person$t items left in.the container or with the remains will be destroyed by the orernation process and cannot be retrieved attar cratrratibn: r ff'' Pine View Crematory • tfltWe heroay awiharixe__-:� _ --- ,c;.ksraxuamy mm to,cremate the remains of tiro deceaeed. (lnitraf OPTIONAL) Ilme hereby.authorize the narnact funeral director to prevfde for deifvefy to and cremation by an alternate crematory,if deemed necessary in the opinion of the feuneratdii-ector,and to emend tine form W.peovide the carried natno and address of such alternate cretnetory: FINAL DISPOSITION: The person authorized to receive the a-emated remains of the decee sad fmrr the crematory is: Name. M.B.Kilmer Funeral Home Aunress: 82 Broadway, crt Edward,NY 12828 Fh7nr: 518-747-9286 The cremated remains of doceated will to disposed of at fell;iwe • It for anylesson the person rIamoc above.does re-Ktaka csaess on of the cremated r ai �h r �emarr,:z, • Pine View Crernetery —'—'- ---, is authr rt ed to give possession of • tie remains to 141.8.Kirrrer Funeral Horne •, • person Of by registered mail. (rovrir-Re i Judith A.hosier DOS-1898-f(Fev,0A120) • Paget of 3 • • • Authorization for Cremation and Disposition tYq/6Ari the following) t P 5 14S ItillAte unr'ersiand that it the remains are not claelred within, 120 daXs,tf crtfa:t, Pine View Crematory • .. •mot • may disoote of the rem:eins In sr irretrievable'manner,such as by ece tering. . .zgt4ATIoN (initial ONE of the following) An urn to be uiert as a container for the cremated rerhains has bean purchased frosri • and is described as follows._ • b'irJe understand that if the.urn is too small to hold tht.entire cisrn?t',ed remains,'awl'sd&tonel.rigid container may:be.used ferdelivery • prr_ . • • +r An uri'y is not yet purchased. UYWe understand'triat if no urn's pPicnasad'cr o+h<rw;3e Provided Pine View Crematory • t will.place tne cremated remains in Cagy ire orrl a r-gid temporary container for dalfvery: by Th.s Autfrorfxatidn Fomr yes pray deaf Stephanie A, Gilman'. • wee executed at �C4YIGtBI,iNOG7 Y VLNB! `-_ . M.3.1<ilnlatr Funeral Homer , rrnasrmirr: xs�vu _ 82 Broadway,Fort Edward,NY 12e28 • • . . [coe of o-A•v W and is rogned by the.t'tneral director as witness to its Oxsoution' . .'.. :. IAA.0 have re eivett a cerripl'.3+fad copy of this ArdhOryzatfos Form. The person(s)identified below fefere the person(e)In.eontroi of•dieposltien,wholly.signing this Atfthorizr►tiott F ein,tittrastisi to the acceracv and completeness'of the Information contained ti aril►At:tharr7,etion Form anti airttsartlze(e rho fore061dg. hL Signed this C ' day of , .� h�i�J> Jz .j 20 „. • Sally.neith dame t s � 7 nAu�a•i±•lnrea-,v—avni . - _ •k._, s � 5O 1 South ll9nnrelara3 nosas , se,FL i4448:Point,M 4 1 o' o 7',e4 a•F.^1bNMC 4 .._ •' _ ,--,. gi�pp --�-----rv' .•— ...�..—.�. • • WITNESS: • siephaniaiA Giinlan 4 uney.rhre{1n typar+.'prism ivinwq. —,.., .. 0; cC?rAt 14153 tFier�a air rulA7 • • Juditth:A.'Huffer • • • 1)0S-1898•f May. i)4r20) 'age 3.of.3