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Strauss Jr., Joseph R Pine View Cemetery & Crematorium Quaker Road Queensbury, NY 12804 (518) 745-4477 or (518) 745-4476 FUNERAL HOME: fie,1PP,'sTod RETURN TIME: DATE & TIME REMAINS ARRIVED AT CREMATORY: 7I21 I ZI l may*1 NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS: 10 - NAME: TOSS1.1 TRAVS5 CASE # Z03 TYPE OF CONTAINER: Fla 1 (Lk . p 7 woof t �F - 1'4f./bac,/ taf. PLACE OF DEATH: 5l j } T©6(* Syi' -( ESTIMATED WEIGHT OF REMAINS & CONTAINER (So /lc / 21 S PLACED IN HOLD: PLACED IN REFRIGERATION: 2.ys\ DATE OF CREMATION: 2 i23 TIME STARTED: =/0,111 TIME COMPLETED: Lifirtti PLACED IN RETORT: 7 40 Pal MOVED: ' 3v RETORT# IN WHICH REMAINS WERE CREMATED: Su Pa. Po ka pprtt DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 48 HOURS FROM TIME OF ACCEPTED DELIVERY: NOTE:THE CREMATION LOG SHALL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY. • New York Stale Department of State ff-1NEWYORK Division of DIVISION.OF CEMETERIES STATE.OF OPPORTUNITY one sh mmnrc.Plan, Cemeteries 99 Nlashrgtor Avert:e Atany.NY 12231.0001 'clephorc (B1E44746226 w;vw dos ny.go.. Authorization for Cremation and Disposition This Authorization Form must be completed and signed prior to delivery of remains-for cremation. Date' 02/1912021 Number 703 Crematory Name: Pine View Crematory Address' 21 Quaker Road,Queensbury,NY 12804 Phone, (5.18) 745-4477 t CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.^•- —._._.�.._._.�._,_..._..___..__.__....._._,_..._,..,._..._.._......_...._._______________._.l Cremation is carried out by placing the remains of the deceased and the container holding the rernains into a cremation chamber where( they-are subjected to intense heat and flame The heat and flame will incinerate.and•consume everything except bone and metal.' which are all that will be left after cremation. Following cremation,the.crematory will take reasonable efforts to remove ail of the remains and other material from the cremation l chamber.but some minimal dust and residue will likely be left behind The crematory will separate incidental and foreign material from I the remains and the incidental and foreign material will be disposed of as required by law. The cremated remains will be mechanically I.pulverized into small pieces and placed into a designated container or urn. Cremated remains generally are pulverized until no single fragment is recognizable.as skeletal tissue. OPENING OF THE CONTAINER The crematory may only open the container holding the un-cremated human remains in limited circumstances,such as to confirm the identify of the deceased or to ensure that no matenat is enclosed which might injure employees or damage the crematory property If 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 opening of a container or the transfer or removal of remains will.be conducted before a witness and will be done in.privacy..with dignity and respect IDENTIFICATION OF DECEASED Name of Deceased: Joseph R Strauss,Jr, Marital Status Never Married Last Known Address: 145 Roberson Road, Shushan,NY 12873 Place of Death Saratoga Hospital Sex ❑O M ❑F Age 74 DOB 10/26/1946 Date of Death_ 0211912021 Estimated Weight j 8U Description of casket container in which remains will be delivered Florence Casket Company (Cardboard Box w/wooden°Base) PERSON IN CONTROL OF DISPOSITION (Person(s)in control of disposition,initial ONE of the following) 1'"'O - I amtWe are the designated agent of the deceased designated in a will or written instrument executed pursuant to Public Health Law Section 4201 -OR- 1'We have no knowledge that the deceased executed a written instrument pursuant to.Public Health Law Section 4201 or a will containing directions for the disposition.of his or her remains and.Itwe are the person(s)having priority under Public Health Law Section 4201 and have the right to authorize cremation of the remains.of the deceased My/Our relationship to the deceased is as follows: Joseph R. Strauss, Jr. DOS-1698-f(Rev 04120) Paoe 1 of 3. Authorization for Cremation and Disposition (Insert from the list below) 5 Rita Dalonzo(Sister) Number Description 1. A person designated;n writing pursuant to Public Health Law Section 4201(3): 2. The surviving spouse. 2a. The surviving domestic partner, 3. Any surviving child eighteen years of age or older 4. A surviving parent: 5. A surviving sibling eighteen years of age or older; 6. A lawfully appointed guardiarr 7. Any person(s)eighteen years of age or older entitled to-share in the estate and who is/are closest in relationship to the deceased: 8. A duly appointed fiduciary of the estate. 9. A close-friend or relative who has executed a written statement pursuant to Pubic Health Law Section 4201(7). -10. A chief fiscal officer of a county or a public administrator appointed pursuant to the Surrogates Court Procedure Act. i0a. Any other person who is acting on behalf of the deceased and who-has.executed a written statement pursuant to Public Health- Law Section 4201(7). (Initial ALL THREE of the followrngj / 'ia'P. I N+le hereby affirm that the body Of the deceased does not contain a battery.battery pack.power cell,radioactive implant, or radioactive device and that any such materials were removed prior to the execution of this Authorization Form Failure to remove these items prior to cremation may result in harm to the crematory and crematory personnel. 1_•_ INlle affirm that instructions have been given to_ Rolland G Haag regarding the removal of any personal property or other thing of value which.any person signing.below or any family member of the deceased wishes to preserve _._ Pine View Crematory s not responsible for the removal of personal items from the container or from the remains of the deceased Personal items left in the container or with the remains will be destroyed by the cremation process and cannot be retrieved after cremation I/We hereby authorize —��Pine View Crematory to cremate the remains of the deceased. (initial OPTIONAL) Uwe hereby authorize the named funeral director to provide for delivery to and cremation.by an alternate crematory,if deemed necessary in the opinion of the funeral director,and to amend this form to provide the correct name and address of such alternate crematory. FINAL DISPOSITION The person authorized to receive the cremated remains of the deceased from the crematory is. Name Compassionate Funeral Care Address 402 Mapie Ave..Saratoga Springs. NY 12866 Phone (518)584-4844 The cremated remains of deceased will be disposed of as follows Return To Family If for any reason the person named above does not take possession of the cremated remains, Pine View Crematory is authorized to give possession of the remains to _,_... Compassionate Funeral Care,Inc by delivery n person or by registered mail Joseph R.Strauss.Jr. DOS-1898-f(Rev 04120) Page 2 of 3 Authorization for Cremation and Disposition (lndiat the!allowing) tJ� I1We understand that if the remains are not claimed within 120 days of cremation Pine View Crematory _ _„-,_may dispose of the remains in an irretrievable manner,such as by scattering CREMATION CONTAINERIURN (initial ONE of the following) An urn to be used as a container for the cremated remains has been purchased from and is described as follows.. IIWe understand that if the urn is too small to hold the entire cremated remains,an additional rigid container may be used for delivery -OR- t e1 •An urn is not yet purchased I/We understand that if no urn is purchased or otherwise provided Pine View Crematory will place the cremated remains in a rigid temporary container for delivery. This Authorization Form was provided byRoland G Hoag P ._.-..._.. was executed at rye:m.;•rat;?.»,",A-a.me; Compassionate Funeral Care.: Inc �.. F'A:p!ai :liar..C. �...F...�._...,...._�,. .._....._._._.�...,.._ • 402 Maple Ave, Saratoga Springs. NY 12866 Un*nywEst: and is signed by the funeral director as witness to its execution 11We have received a completed copy of this Authorization Form The person(s)identified below is/are the person(s)in control of disposition,who by signing this Authorization Form,attest(s) to the accuracy and completeness of the information contained in this Authorization Form and authorize(s)the foregoing. 19th February 21 Signed this __..day of __._..,20 .,:;tea?ruled Nilme sA;, cej _.._......_. 8.Oakland Drive,Port Washington,NY 11050 Mary Ann Bartlett 12855 Runway Road,Apt 3-202,Play Vista. CA 90094 ..:mS5 WITNESS: Rolland G Hoag t-;.rem 1)9rd .,taTif: 11636 Joseph R.Strauss,Jr (Name of Deceased) �— DOS-18984(Rev 04/20) Page 3 of 3