Paige, Steven Allen Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: t1WQ RETURN TIME:
DATE & TIME REMAINS ARRIVED AT CREMATORY: ` I ii I ZL '1
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
ft LWA1=..c.
NAME: 57-F v Eh) 1'A-1 'E CASE # 41 J
TYPE OF CONTAINER: m 00AI1 Bit( ( (604 ( t;avr
PLACE OF DEATH: 144 (Aire Tailiu�JFl� }TLOI')
ESTIMATED WEIGHT OF REMAINS & CONTAINER Z 7 s fir 3 B3 g5iJe
PLACED IN HOLD: / :008/7
PLACED IN REFRIGERATION: 4'
DATE OF CREMATION: S1/3--
TIME STARTED: /y_. TIME COMPLETED:
PLACED IN RETORT: 3o�, _ MOVED: 7 -
RETORT# IN WHICH REMAINS WERE CREMATED: Ju pier rzA2C - eeLA
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.
. 1111111111Mme
Department of Stale
NEW YORK Division of DIVISION OF CEMETERIES
Cemeteries
Authorization for Cremation and Disposition
Aohorizat,on F r.,rm must be completed and signed prior to delivery of remains for cremation
rie
"—"
,iiew Crematory
44--
Phone
— — — —— — —
CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS.
the remains of the deceased and the container holding the remains:nto a cremat on r.ramr,r rri
" It . r ce e3t and flame The heat and flame will incinerate and consume everything except bone and metal.
which are all that will be left after cremation.
• t_rer-,3tory will take reasonable efforts to remove all of the remains and other material from the crerr,at on
' t at oust and residue will likely be left benind The crematory will separate incidental arid foreign rnaer.at
jr 1¶ ,.,:x,to and tune gn material will be disposed of as required by law The cremated remains will be mechanic
HO !rt 4k 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
I tt,7T v y 6r open tile container holding the un-cremated human remains in limited circumstances such as V>conr.,m
noritty ,`th• dereasi:a c to ensure that no material 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
recta ner the tra,,s!er or removal of remains wiil be conducted before a witness and will be done in privacy with d'anity and respect
IDENTIFICATION OF DECEASED
Stever Alen Page Divorced
Name of Leceased Marital Status
4 Corks V,,,ay Long Lake NY 12847
Last I`LV1 Address
on Lake Transfer Stat,on,8160 Newcomb Rd Long Lake NY 12847
Place cif Cath
——
47 4/11/1975 8/8/22 275
Se M 0;. Age DOB Date of Death Estimated Weight
Desu ct on o4 casket,contamer ii which remains will be delivered
MacDonald Basic Cremation Container
— — ——
PERSON IN CONTROL OF DISPOSITION
nerss,n(s, rorrrni of glspos1ton initial ONE of the following)
— — —— a 71'We are the designated agent of the deceased designated in a will or written instrument executed pursuant to Pubi,,,
Sect on 420'
„;... • !la,4; nr, kiii3,yledge that the deceased executed a written instrument pursuant to Pt.Vic
ota n"1 for the d'Pos!tion of his or her remains and I/we are the person;st having pnorty under Pue,,c Heam!
',1rt cf Inc remains of the deceased MylOur relationship to the deceased is as
follows
Steven Allen Paige
Authorization for Cremation and Disposition
2.a
3
4
5
7
8. ;., . :.
9 i, .
., 1 -i, .. .. r r ,�- "7 ci .. r^S'-34H'"o-°' C x.ar"^ _ ..
10 u •
., r .. d ;,.;b a p,.t,'<^:':PurSi;an.,.,,ht.
10a, n c r'rr r t cha f of tine d_!.case°and,rho has executed a ..r,t; ' ' •
d r,
Nve here b,,atrirm tha",the aooy of the deceased does not contain a battery battery,pao pacer r!i rod 2:-t :;• -r
a:.u� t. e dp,ct and trial ary s.len materials.r,ere,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.
Patr.cia Miller
I/We affirm that instructions have been given to
regarding the removal of any personal properly or other thing of value which any person signing below or any fam:l',r ,nr_•r°'th•:
Pine View Crematory
deceased wishes to preserve
,Ceer df,,q
IS not responsible for the removal of personal items from the container or from the remains of the decease° 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
IIWe hereby authorize
tc,er>'5 'F Na'.',
to cremate the remains of the deceased.
(Initial OPTIONAL.)
I/we 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
Miller Funeral Rome
Name __-
6357 NYS Rte 30, Indian Lake, NY 12842 518-648-0011
Address Phone
The cremated remains of deceased will be disposed of as follows
returned to Stevens family
If for an;r+ason ln,, pr:iron named shove Glees nol take pr.,ssession of the cremated rema!ne
Pane Vi-.a Cr,-o1-_eery.
h s ,
uneral Home.
Steven Allen Paige
Authorization for Cremation and Disposition
gREMATIoN CON1AINERil3RN
i Ce used e5 a c ora r,r for the Crenated rema,ns r.as been purchased trcrn
06,2,1<,
� ,,
it,hF urn t5 tS:u Smell to hmt(�me enLre Cremated remains an addl.,]'1a;old COntau.rr may't'�u u�_ ii
An urn s, not yct purchased ifdJe understand that if no urn is purchased or otherwise prov.ded
-one ',new C'ematory
place the cremated roma-re,
a meld temporary r.onta:ner for delivery
Patricia Miller
This Authorization Form was prooded by —_,vas executed at
(Ft.' a;f4..›,e 3m
6357 NYS Rte 30 Indian Lake NY 12842
aner r ncnv
and is signed by the funeral director as witness to its execution
tfWe 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.
L' August 22
Signed this day of ,20
Barbara E Paige L
291 Northgate Village, Burlington NJ 08016
Cy r
WITNESS:
Fatncia MdIE i \pcirtuktsotat
Steven Alien Palau