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Hardman Jr. Edward J Pine View Cemetery & Crematorium Quaker Road Queensbury, NY 12804 (518) 745-4477 or (518) 745-4476 FUNERAL HOME: Brieca. per Egml 1T RETURN TIME: f U-0AV DATE & TIME REMAINS ARRIVED AT CREMATORY: Z 17 7 1 6b2Nill NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS: c062m NAME: ED LiiVRD tiA1Z&"i f S� . CASE # 1) TYPE OF CONTAINER: flbitEuGF /flsea- FBLE,00tkczo PLACE OF DEATH: IS'ro € /16 SA 1-1. ESTIMATED WEIGHT OF REMAINS & CONTAINER /S0 /lc / 1lb ����• �� PLACED IN HOLD: PLACED IN REFRIGERATION: 1`i If DATE OF CREMATION: 2 1 Z3 1 ZL3 TIME STARTED: IC 411 TIME COMPLETED: ' oa 1i PLACED IN RETORT: -) 20 114-1 MOVED: g- I S I`� ( g Lf0 tztil RETORT# IN WHICH REMAINS WERE CREMATED: Su f 64 Nei PA k 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. +cW`!o;,Suite Department of State NEWYOIRK Division of DIVISION OF CEMETERIES STATE OF One C_om.rerce Plaza OPPORTUNITY- 99 Washington Avenue • Cemeteries A.:Oani,PAY 122.31-00Gt Teiephorr:(518)47 -8228 w•ua:.Oa..nysov Authorization for Cremation and Disposition This Authorization Form must be completed and signed prior to delivery of remains for cremation. Date:FEBRUARY 21, 2023 _ c Case Number(for crematory use only): 2023-0ri / (� Crematory Name:PINE VIEW CREMATORIUM, Audress:21 QUAKER RD QUEENSBURY,NY 12804 Phone: 518-745-4477 I CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS. Cremation is carried out by placing the remains of the deceased and the container holding the remains into a cremation chamber where they are subjected to intense heat and flame. The heat and flame wilt incinerate and consume everything except bone and metal, which are all that will be left after cremation. Following cremation,the crematory will take reasonable efforts to remove all of the remains and other material from the cremation chamber,but some minimal dust and residue will likely be lett behind. The crematory will separate incidental and foreign material from the remains and the incidental and foreign material,including dental work and implants,will be disposed of as permitted by law. The cremated remains will be mechanically pulverized into small 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 The crematory may only open the container holding the un-cremated human remains in limited circumstances,such as to confirm the identity of the deceased or 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 container or the transfer or removal of remains will be conducted before a witness and will be done In privacy,with dignity and respect. IDENTIFICATION OF DECEASED Name of Deceased: EDWARD J. HARDMAN, JR. Marital Status: NEVER/SINGLE Last Known Address:156 LAWRENCE AVE APT 116 SARATOGA SPRINGS,NY 12866 Place of Deem: 156 LAWRENCE AVE APT 116 SARATOGA SPRINGS,NY 12866 Gender- l 1 M©F g X Age:82 DOB:10/04/1940 Date of Death:02/2012023 Estimated Weight; 150 Description of caskericontainer in wnicr,remains wilt be delivered,including manufacturer or supplier and material. FLORENCE CASKET COMPANY CREMATION CONTAINER FIBER/CARD BOARD PERSON IN CONTROL OF DISPOSITION (Person(s)in control of disposition,initial ONE of the following) I amnJWe are the designated agent of the deceased designated in a will or written instrument executed pursuant to Public Health Law Section 4201. -ORaj ;,!) l� INVe have no knowledge that the deceased executed a written instrument pursuant to Public Health Law Section 4201 or LLL }} a wilt containing directions for the disposition of his or her remains and Ilwe are the person(s)having priority under Public Health Law Section 4201 and have the right to authorize cremation of the remains of the deceased. My/Our relationship to the deceased is as follows: DOS-1898-f(Rev.01/23) Page 1 of 3 Authorization for Cremation and Disposition (Insert tram the list below) Number. r Description: NIECE 1. A person designated in writing pursuant to Public Health Law Section 4201(3); 2. The surviving spouse; 2a. The surviving domestic partner, 3. Any surviving child eighteen years of age or alder; 4. A surviving parent; 5. A surviving sibling eighteen years of age or older, 5. A lawfully appointed guardian; 7. Any person(s)eighteen years of age or older entitled to share in the estate and who is/are closest in relationship to the deceased; 8. A duly appointed fiduciary of the estate; 9. A close friend or relative who has executed a written statement pursuant to Public Health Law Section 4201(7); 10. A chief fiscal officer of a county or a public administrator appointed pursuant to the Surrogate's Court Procedure Act; 10a. Any other person who is acting on behalf of the deceased and who has executed a written statement pursuant to Public Heaith Law Section 4201(7). For numbers 3,5 and 7 above,by signing,the person(s)signing this Authorization Form represent that they are signing on behalf of a majority of the members of this class of persons who are reasonably available. /(initial BOTH of the following) llWe hereby affirm that the body of the deceased does not contain a battery,battery pack,power cep,radioactive Impiant, or radioactive device and that any such materials were removed prior to the execution of this Authorization Form. Failure to remove these items prior to cremation may result in harm the cr tory and crematory personnel. nt i Wve affirm that instructions nave been given to • .�Pi1?AS` C r i f r °wea wee/ regarding the removal of any personal property or other thin 1 val�ue)wh rihany persoe gnrng below or any family member of the deceased wishes to preserve. /4 V-e6(- r�day N9 /(9��vdn is not responsible for the removal of personal items from the container or from the remains of the deceased. Personal items left in the container or with the remains will be destroyed by the cremation process and cannot be retrieved after cremation. (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 final resting place for the cremated remains of the deceased is RETURN TO AWSON OR MARINIE If the funeral director whose signature appears on page three of this Authorization Form is not the person authorized to receive the cremated remains of the deceased from the crematory,provide contact information for that person or persons: (Hama) —ice (Mons) If for any reason the person named above does not take possession of the cremated remains, PINE VIEW CREMAORIUM is authorized to give possession of (Cnmalay Name) BARTON-MCDERMOT FUNERAL HOME,INC. by delivery in the remains to thalami Home Name) in person or via delivery by the United States Postal Service,as permitted by its regulations and procedures. Page 2 of 3 DOS-1888-f(Rev.01/23) Authorization for Cremation and Disposition (I,if-Aire foliowirl y) + .„ _INVe understand that if the remains are not claimed within 120 days of ctemabon, rs PINE VIEW CREMATORIUM may dispose of the remains in (Names a Gi...ory) an irrettievabie manner,such as by scattering. CREIviATION CONTAINERIURN (Initial ONE of the following) liWe have provided r •,164/4, .) with an urn to be used as a container fec the cremated (Nampo rtC,m y) remains.The urn is described as follows: • liWe understand that if the urn is too small to hold the entire cremated remains,an additional rigid container may be used for delivery. -OR- ..i E tfWe have not providers an urn to be used as a container for the cremated remains,and understand that PINE VIEW CREMATORIUM will place the cremated remains in (N.:me a Crerma.o y) a rigid temporary container for delivery. JAMES P. McDERMOTT was executed at This Authorization Form was provided by_ (Fmrcral uratorName) BATON-McDERMOTT FUNERAL HOME, INC. (Foetal Motor Name) 9 PINE STREET/P.O. BOX455 CHESTERTON,NY 12817 (Fumual Home Address) and is signed by the funeral director as witness to its execution. 'Me have received a completed copy of this Authorization Form. completenesss)to the accuracy and o i nss oof thet inforn control of disposition,who by signing this Authorization rmation contained in this Authorization Form and hereby authorize(s)to(cremate the remains of the deceased. 21TH FEBRUARY 20 23 Signed this day of •a o , ; t� ALLISON PULLEN_ ,,,sLaH\ aarWa Typed orPrimrad Name PLACA JOAQUIM PENA 61 BARCELONA, SPAIN 08017 Adams. - yprwluro Typed o,Pnntad Name A7dreiss' --- -- syamura Typed orPtimv dName AVMS WITNESS: JAMES P. MERfiIIOTT _ r�rarareer�� ) (Fum+ni 0uector Ty or Pdrxed Name] 12330 (Rego ation Number) Page 3 of 3 DOS-I996-f(Rev.01/23)