Prouty, David Michael Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: E D1 s RETURN TIME: ,✓J14
DATE & TIME REMAINS ARRIVED AT CREMATORY: /`01—
12 3/-ZaZ Z
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
lie.Aia ELL 1,'(
NAME: �c% CASE # /
TYPE OF CONTAINER: 4 6-65---lo `N /0 Ave Cp,,,-4; ,
/77 ,e, �Gr1(�✓vim
PLACE OF DEATH: 2 2 7 56 v-1-1,4_ —1 G/C /v . l/S, AA y/1
ESTIMATED WEIGHT OF REMAINS & CONTAINER /7 1 h�
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: /Z-3/ z'Z Z
TIME STARTED: //3-*L--- TIME COMPLETED:
PLACED IN RETORT: i MOVED: /g-6.
RETORT# IN WHICH REMAINS WERE CREMATED: 3:-/P-er P()L C ( cc-('1
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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