Benjamin, Kathleen S Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: P I .►o'i(c. RETURN TIME:
DATE & TIME REMAINS ARRIVED AT CREMATORY: 1+ 1 II (1 2.11C01-1
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
NAME: lokt4A tJ Bet1 't N CASE # 143
TYPE OF CONTAINER: rvk 4141 4.160(11l/ +I
PLACE OF DEATH: A i L 4,1 N(Lt�[L• (�.v{�f'
ESTIMATED WEIGHT OF REMAINS & CONTAINER go
PLACED IN HOLD:
PLACED IN REFRIGERATION: zA(Qil
DATE OF CREMATION: //20- 2./
TIME STARTED: TIME COMPLETED: /Cli—
L�
PLACED IN RETORT: 7 c MOVED:
RETORT # IN WHICH REMAINS WERE CREMATED: 3c " eecd-r 5- 'c.L
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.