O'Brien, Patrick LPine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: — hT C� RETURN TIME:
DATE & TIME REMAINS ARRIVED AT CREMATORY: 511g It 5 2;�s��`1
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
NAME:
CASE #
TYPE OF CONTAINER:
PLACE OF DEATH: Z� �ycr'2V ��c L IA NE (dll IOU_ PY (ZqK�
ESTIMATED WEIGHT OF REMAINS & CONTAINER (gS- (4, ..-�4�
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION:
TIME STARTED: Iz % Olt)
TIME COMPLETED: � •16'�Pl7
PLACED IN RETORT: (2%30 YP1 __MOVED: _ I� �cf h �,W�j-7
RETORT # IN WHICH REMAINS WERE CREMATED: ga*" '"k( kle
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.
13
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