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Donaldson, Joyce Pine View Cemetery & Crematorium Quaker Road Queensbury, NY 12804 (518) 745-4477 or (518) 745-4476 FUNERAL HOME: /�P/`fy RETURN TIME: 4�/d DATE & TIME REMAINS ARRIVED AT CREMATORY: �� — /D a�'—Z ' z: NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS: Rv /e kJrn NAME: �P> C� �Dciii/r1 Sp CASE # (5zy TYPE OF CONTAINER: PLACE OF DEATH: ircZa bc +0tAl,i Cem1Mrnn� l� �toSPi �tii� 5/,`z4 6 , n/y /, 5 72 ESTIMATED WEIGHT OF REMAINS & CONTAINER /,a /i 5 bea SC e PLACED IN HOLD: PLACED IN REFRIGERATION: DATE OF CREMATION. ,_ _ _ _ I D/31 1 Z L TIME STARTED: $=001111 TIME COMPLETED: ID"to I' PLACED IN RETORT: '3 D 1 MOVED: q• 15 It � qb RETORT# IN WHICH REMAINS WERE CREMATED: -S u PX P oduz 'Pa I. /a/ 'r 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. TOWN OF QUEENSBURY PINE VIEW CEMETERY & CREMATORIUM Quaker Road, Queensbury, New York 12804 Phone (518) Crematorium 745-4477 (if no answer) Cemetery 745-4476 AUTHORIZATION TO CREMATE The undersigned requests and authorizes Pine View Crematorium, in accordance with and subject to its Rules and Regulations to cremate((�� the remains of: rr jpyyf4— Odi?A ICIS00 Fern A/ -e__ ('NAME) (SEX) �y IA q VAS ``r9 .7,) art, llf ✓14 `44- icy. ) v'U i (STREET) (CITY) (STATE) (ZIP CODE) 7-71 who died on ! ? day of (=- C G U ,--' 20 9_0), at EA 2a-4- -N L I t)Si `101 Z ' 4 6-ei YT e 4,2 A96 /a y3 - (PLACE) (ADDRESS) Name and address of nearest living relative or name of person authorizing cremation: IytiAi OvNAldsCIU Relationship to deceased ct Augkti- Name of Funeral Home&dt&Ar& X. e f/ cvAiev-At W041-4— IMPORTANT I represent that to the best of my knowledge, the deceased has o has no)acemaker in his or her body. (CiRCLE ONE) I certify that I have the full power and authorization to arrange for the cremation of the remains and to direct the disposition of the cremated remains, that any personal possessions have either been removed or may be destroyed, and agree to protect, defend and save harmless Pine View Crematorium from any and all claims and demands for loss or damages which may be made ag • st them by rea on or connected with the cremation of s • re ins as dire ted, whether laims or er► e e noyelll�gr�ugdl se tr d it r . (04 4/ WITNESS) (ADDRESS) `7)1.,l -•- - /3 7 9 C -1 )ill'd S�,an ce (SIGNATURE OF RE TIVE OR LEGAL REP. AND ADDRESJ7 Signed on this date: -� / /_ Pine View Cemetery & Crematorium Quaker Road Queensbury, NY 12804 (518) 745-4477 or (518) 745-4476 FUNERAL HOME: ST/`f RETURN TIME: 4//I DATE & TIME REMAINS ARRIVED AT CREMATORY: / /12 o?9—ZrJZZ NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS: NAME: f,/ce �Dn��i/ CASE # (54( TYPE OF CONTAINER: 1 tvrt.6v'E h\ie 71, / tliectO 001 PLACE OF DEATH: 6- z bc14'Vl +0 ut1,J vYr1 Nt(A A), Sri z 6 e-E(A—I-A,.) , /�6 7- ESTIMATED WEIGHT OF REMAINS & CONTAINER /02/ 5 /Sea) �l� $cPLACED IN HOLD: PLACED IN REFRIGERATION: DATE OF CREMATION. , _ _ _ /0 I31 12 L TIME STARTED: i=CO fir TIME COMPLETED: ID 10 1 PLACED IN RETORT: '3 0AliMOVED: 61• 15 /11 1 � 1b !1 1 RETORT# IN WHICH REMAINS WERE CREMATED: S ` P 1 Pau-uz 'PA /a/oicp 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. TOWN OF QUEENSBURY PINE VIEW CEMETERY & CREMATORIUM Quaker Road. Queensbury, New York 12804 Phone (518) Crematorium 745-4477 (if no answer) Cemetery 745-4476 AUTHORIZATION TO CREMATE The undersigned requests and authorizes Pine View Crematorium. in accordance with and subject to its Rules and Regulations to cremate the remains of: f,,,i„ ,5 0 0 F--,,,A re___ ('NAME) (SEX) fed Via- ()s gr 9 , cJra) 411 !�¢-- IU,1. 1 7� (STREET) (CITY) (STATE) (ZIP CODE) 1 who died on Pi t day of £- v Y 20 9-a--, at E! 1 2 i-e /le4'x) Wes ;`A/ c7!/�A 6-e 7 ' 1 a 93— (PLACE) (ADDRESS) Name and address of nearest living relative or name of person authorizing cremation: l y /0AI OcnjAidS0IL) Relationship to deceased r Auci ii ✓ Name of Funeral Home ed.&Ar-& /. fie. /1 roJev At }4041-e- IMPORTANT I represent that to the best of my knowledge, the deceased has o has no acemaker in his or her body. (CIRCLE ONE) I certify that I have the full power and authorization to arrange for the cremation of the remains and to direct the disposition of the cremated remains, that any personal possessions have either been removed or may be destroyed, and agree to protect, defend and save harmless Pine View Crematorium from any and all claims and demands for loss or damages which may be made ag . st them by rea on or connected with the cremation of sa. re ins as dire te��ether yh laims or!%e e e no ll�giugdl se tr dpl it 1 .37 7 t-le 1r ///'d SCf,-17e:.a &- WITNESS) (ADDRESS) •/O y- /3 7 9 C --1 ) 14i S an i-Gik (SIGNATURE OF RE TIVE OR LEGAL REP. AND ADDRESW Signed on this date: '7/©�