Hanna, Tmothy W Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: n rtLottil RETURN ME: tilE0tMoirr
nv-
DATE & TIME REMAINS ARRIVED AT CREMATORY: 1 13 Z%bv
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
1644 iett PitZ
NAME: TT -POW A CASE # SAS
TYPE OF CONTAINER: 17OcGcl 1J4I i -a.e ItIL,aq(
PLACE OF DEATH: II1.n7 Madt<<I
ESTIMATED WEIGHT OF REMAINS & CONTAINER H$O / /if S.1.
s.
PLACED IN HOLD:
PLACED IN REFRIGERATION: 2�16 I I
DATE OF CREMATION: Mite/ VI
TIME STARTED: % 301111 TIME COMPLETED: f'
PLACED IN RETORT: � 'LID yinMOVED: $ so I*/ `i w,q i
RETORT# IN WHICH REMAINS WERE CREMATED: P0Iui Z NM
J
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.
• s ... ` `:a. ,a - q _ '°
;iK" _ ." "
F wya.. ">4',.'e '„
�'�s :�"nx .4y �Ph . '. •
ac.'
•'t' T,,
r .
rx..
}
ati,
... .. :.
,yn.:,, ^"a e�L"'s'"'ti.
5: t
N "i�-$- y^'?S-^ y: ,,.5 •t5 y.`; "r Y},�`w `?X'r Y:. - ir:}
G '€� ..s.:.. s am` ^&W,.`
ti
a " , _ - - s' '-v:°," -
�N
.>u
~'
n ,,. • - - -
8R'r.rv' - fib. , _ _ •.
container Or the transfer or removal of remains will be conducte..4lr''a "witness and will be done in privacy,with dignity and r:; =
` OF D 1Divorced
4 . ,,_ --'..';., Marital Status:
-,' :'4i. c. r:t, .:r-=. `!_sue„X - _ - ..
:�56� ,:-X S•�`= �'.'�Y1,.''• -k;H:,e .,=il3:C,s
, -
4.
.s3,- -
.-Yrc tr�".'._'.' »5N' - ";n, t .a:e'�'+:``�'' i^`- ES. '�'C;.Nt,. ,'.pp;,`.�s'
b�
' �. - �iS'`-�L'^'Tet•pus
ter-t :*:, � y R- ':!
c"'
" J " �. f1' i' hpy -r •cW " $?r + f 2r
-ue - - .F a
•
._ ....Y,^+ ;,�.r ... ,.rr" v._.;/:,r^>� -_ j�'d::`s.a: .rr,<�`n', a-3,t,1.:- - - z.,e,
.„,r .:r �._•.. ,.,"Se w.ry .w,�.M.:.fi:c.' - - - -i� i-tl+� aJ/�'frt 35,e.
��.. si. x .ski T -
1ii ri� rT
5 'n>'n �s �~
dr":., <� '- ,. 4r„,�.. '4;4. .�`,nr�':':w:"-,y� ,;.v'•„�><_ `'�'•''
-y:
- �.,4 �.#�i`np'e 'ten" ..€:�°v. Y .k.
?'
s"%=;At'; ..;�.; ..%`�'' �;ry.Q a'a„.a•.;,r`KSg' _ �.-,:"4.;>.-s.�^i�°.u�i�:..�, -
s ?.
•' s
ti.
:.`. =F� xa3 � 16 e „
3
�s •z
-: nZ ], Y
4 3 x-v F:
, F
f^ 3 4�� �'3: t�* ram:•. ;
• ., .. � - .. ,,.,. .. ,�a.> ;:+i:,?fN t "` „''��'a""`r';•� .,: r, . .�,�," , ..- 5�5�•
•
'`' h...' �' ., �5. '�' A Y*d �q'�'7'° y_p 'cam'�„
•
,��iRST�-�� Cr �'�+£ �+� ,t`�.. '�d''� C--fi-S �''` o•::
'^ -£5 +ASS§'R. ! .aez` .ry`n '!` ,, ry 4 4 r
� t
� f kr i .. o a s' -. z
VA
• - " - ye,s ( �, '�t i a n �� .,
plioty
x �.. d�c�,,,,r,��?�� , 1 ft. '='gyp,-' fig' f
-3-;-,;-?--,-::.-z..;;;;.. ,-.-:-:. -. -;--;.-,,,r.,i.,.;-.4,,,,-„,---;c....4-,-,41,,J1.11,!--- .4146"1;i0171, „ .,-,,..'4::- .4.*;?-2,-4.,:q.';:-,:',;,---:;-__,...1.,,,-,r"---i--1;_tfr,14','.' '-:.r:,;--,
4..1041...„,,,
l.; f 7 Y .-�` t ,r .i w i t M..!' tt L t w .`�,, �': R:S `?`4y5 . �t-,S.
rr' i.. ,,,.iz,-u' '3fi� tea-`� P.' .- Yt'.._ ..- - _ a.S?` ,r _ .w�s4 -
fi w"i t `x y't�
't
:i:is
'4t
tB&Ff'YF�,y d
7 iY
kV'
i !y.
,j s
int1111.10/110d*tit.tumoral director as 1Mtness to ItE
_•