Bennett, Michael M 411111)
Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: r1 ( . RETURN TIME:
DATE & TIME REMAINS ARRIVED AT CREMATORY: 3 113 ID 1i.D6 6`
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
fey M
NAME: ttAvviok DopikTr CASE # Z33
TYPE OF CONTAINER: MCAIUp Pr(4) (DNfl3 t' - 1541-57-C
r(149000 610 r LSD
PLACE OF DEATH: 1 I Z 5 k, .9 a Ro"4, C , 17 g.3.
ESTIMATED WEIGHT OF REMAINS & CONTAINER 'SO
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: I(13 1 Z3
TIME STARTED: IZ;Hsph TIME COMPLETED: z'� h
PLACED IN RETORT: 12 SO01 MOVED: j tjc f 2 i0 r)
RETORT# IN WHICH REMAINS WERE CREMATED: Svwc,g• ftwuz °AI(
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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Diestartmenl of State
er jr-tirIEW YORK Division of DIVIS/ON OF CEMETERIES
S TOL Of
OPPORTUNITY Cemeteries in A orniei
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Authorization for Cremation and Disposition
Fcrni must tire:eradfeted and signed prior to delivery of remains ter cremation
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CREMAT Cf PS AN IRREVERSIE-E AND FINAL PROCESS
a: e a-s.••-e 3-: ::-:3-a l'e•e -s ne•e-e
-.a. -",- e2".5- •3-e The heat and flame Rill incinerate and consume everything eizept bone and metal
hich are all tnat oe left after cremation
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e:- :a , ie 0eCeanC aCce: a des;,-31e: Z Cremated remains
gent.ra• ily se 0 diverized until nc single'ragnnent is recognizable as skeletal Us sue
OPERA('DT'HE CONTA:NEF
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remains are delivered in a container which is not suitable for cremation such as ceremonial or rental casket the
Crematory Anti require that the remains be moved into a suitable container before it accepts the remains e"3
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QENTtFICArON OF DECEASED
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to one deceased is as follows
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Authorization for Cremation and Disposition
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Authorization for Cremation and Disposition
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: •: — ALdecrizatmn Fur- Failure
e these items oi.: emotion may reSult Narrn tC the crerratcry anc crematdry pe•sc,nra,
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;terns left in the.CCntaerpe,:VI with the remains well be destroyed by the cremabon process anti cannot be retneved
afte:crematicn
ne:eo,authcrizetre 3ed 4uneraldre:tOr to provide for delivery to and cremation by an alternate
ematory if deemed necessary en the opinion of the funeral director and to amend this form to provide the
:.crrect name and address of such adernate crematory
P;NAL SPOSI'ON
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At-is are tne perszni ,,n:..ontrol 0'Clain stitch who try signing this Authonzation Form attestist to the aczkyracy and
::,-lasetersiess ot tne information containea in this Aathanzatron Farm and hereby auttonte1s)to cremate the remains of the
7eicieaseact .
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