Acosta, Ricardo Rafael !,, L )
Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: . _ It\MSOrJ RETURN TIME:
DATE & TIME REMAINS ARRIVED AT CREMATORY: ibIZt i tt 4>00M
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
55_.r'13491ill _..Aft...._
NAME: 11 GIARO0fL.D _ CASE # -q j g - ...- -
„-___.
T''PE OF CONTAINER: PHI-Li 7 (4a `s__ l ,( /G�i?n tfr
-..�.��tJ ._ _..!s a -
PLACE OF DEATH: Y L .)00,jW ROf..P, Mc t �cxv.__SPfj1-ll' I /1.
E:JTIMATED WEIGHT OF REMAINS & CONTAINER 3-s.0--_-.__-_ij s__ ...__.--..-_
PLACED IN HOLD: — - 2 ISTri
PLACED IN REFRIGERATION: -..____...
DATE OF CREMATION: _JO-Z"Z Z
.-pir'- TIME COMPLETED: ID
10,
TIME STARTED: � _ _ _ _
n - q
PLACED IN RETORT: 7 _ .. MOVED: 9 ` L / --
RETORT # IN WHICH REMAINS WERE CREMATED: S,�per_a -v.. (�': g---
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.
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