McSpadden, Richard Gibson Jr. LF
Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 or (518) 745-4476
FUNERAL HOME: ti trA,wea, RETURN TIME: ft) fP (CALL
DATE & TIME REMAINS ARRIVED AT CREMATORY: 10 (3 I l3 2;40QIi
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
40D ICMt Mute k �fSE
NAME: Rtc N,Pr2D HC,S f P DO @. CASE # 1 Q D
TYPE OF CONTAINER: I co Gti 1'F\s(
f pG `tt eo60Az
PLACE OF DEATH: 27 figpot, giec PtAczo 17011
ESTIMATED WEIGHT OF REMAINS & CONTAINER I SL ihs- 5lwtrc{
PLACED IN HOLD:
PLACED IN REFRIGERATION: 2.GT-Pp-?
DATE OF CREMATION: %d l q i L3
TIME STARTED: TIME COMPLETED: I Pr
PLACED IN RETORT: P MOVED: g 35 I 5. / J
RETORT# IN WHICH REMAINS WERE CREMATED: „cigr g- Tottirit
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.
10,ji23,2:16 PM Cremation of RG McSpadden 2.jpeg
Nrw Yort S"tatc
Department of State Department of State
yp DIVISION OF CEMETERIES
99 WasFrgton Avanur-
ArW-ry,NY1773t-OC 1
T.aiap3irre:I:,11ZJ i7S-E374
ells,+dc6 ry,pDv
Authorization for Cremation and Disposition
Tiffs Authorization Pisan must be completed and signed Marto delvirery of moraine for crernarbn.
63
if this form it not property pprynpletad or executed,the crematory eery Most dslhiery of the Mann remtinx
Dace:0.1.2172023 Case Nurhocr „._ 1 R
.., nerratny Laecrar;
Cnlmaton.Name:{rl View C7ernatoly
Address:21 Quaker Road,Queensbury NY 12804 Phono:5 d8-745-4.477
CREMATION iS AN IRREVERSIBLE AND FINAL PROCESS.
Cremation le canted cut by placing die remains ere deceased and the eontair,er holding the rerlts:Ma Mu a cremation charncc-wdlerle
they are subjected to intense heal aaxr Fame. The heat and flame will incinerate fed corcavrne everything except hone and metal,
which are all that will be left after cremation_
Following cremation,the lxamatory wra truce rr ssonatrie efforts to:remove;,l or t^c remains and othermatend'from the cremation;
chamber,but some minimal dust and residue will nicely be left betetd The amatory w E separate inode11al and foreign mateha from
the remains and the incidental and foreign mafrr;af,including dotal work and Moans.will be disposed of a%poreiittod by law /he
cremated teme ee will be metttaricalty pulverized into small pieces and placed into a designated centimes ur urn Cremated remains
generally ere pulverised until no single fragment is re ognitable as skeletal tissue
ID RTIFICATION OF DECEASED
e Name of Deceased: Gl son McSpadden,Jr Marital Status:Attained
E:tat Known Addr x 8417 Pine Bluff Head,Frederick Md 21707
Place of Death:Municipality:take P3cid Airport,27 Airpd t Lane. Lake Placid,NY 129,4State: NY
Gender: ElM f'El X Ape.63 Dl7[j °6-O9-f i160 f3a a i t Dr:xlh 10 Dl 2l}23 E.%ima i Weigh! , '
Ot'LNMIG OF THE CONTAIN
The crematory may only open the ocrlkiincr tlol&sar the un-crernalad human remains:in limilad circumstances,such at to ccninn the
ids City of the deceased Of to ensure that no motorail is enclosed winch might injure empbyees or damage tf e uesnfitay property If
human remains are dehvorod at a writafee%filch is net for crernatan six),as cereroardal or rents casket,Me crematory wit
require that the remains be moved into a suitable cantina before it:of laa roe remains The opertv of a container or the traiefe ur
removal of remains will be ooriLictird before a walnma and*Ali be done in privacy.with dignity arid ruspoca
D CRMTtON t:DNTA$I fN WHICH RFINAINS ARE[3Ej MG_DELIVERED
Manufacturer or suppt cr Minumurn Cremation Casket Florence Casket Co.Ca:aboard/Pine
Mattv4tl._
CREMATION CONTAINER IN
(fah(ONE of me Wowing)
Pine View Crematory
Wife hairs provided with an urn to be used as a coma mc7 icz the
(Rare 0r3w;uGy;
cremated remains.Me encierster4 Mat i"the urn s too Small to hod the entire anniated,emairc an arldibonal uigse.
container may be used nor delivery.Description of um
Afar have not provided an urn to ac usca as a container far the crenated renrar ,and understand that
Pine View Crematory wit place the cremated remains in
.:fewer rdaarnalo r ... ..
a ngid oonteiner for delivery.
DO&t845 f(Rev.064?3) Page 1 of:I
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10/3123,2:16 PM Cremation of RG McSpadden 3.jpeg
Authorization for Cremation and Disposition
PER TINCONlJROLOF4r g179pt
(Persorl{s)in torero/or Corr,Er0,11 ONE of the foNowngi
1 smliNe are the designetod agent of tee deceased desgnaeed in a wit or written aistrurn&'t exedeed pursuant to Public Health Law Sect cis 4201.
-OR-
o have no knowtedgo that the deceased executed a written instrument pursuant to Peale Health Lew Section 4201 or a
wf3 containing directions for the disposition of his or her remains and ewe are the person(s)having moray under Public
Health Law Section 470t and have the nght to authorize oemabon ofllto remains of the deceased Myra relationship
to the deceased is as Follows.
Number:22 Description:The surVi ring spouse
2 The aiavivtng spouse:
la. The surviving domestic partner,
3. My surviving child eighteen years of agr;or older,
4. As—ermine paean!,
S. A surviving sibling eighteen Ads of'vet.or older
6. A appointed guardian:
7. Any person(s)eighteen years of age or older entitled to sham in the eseeto vise who is/are cksost sn rulatzariship to
the deceased:
8. A duly appealed 1lduaary of the estate.
9. A close friend or relative who?lass executed a wnitnn statement purstrh to Public 4catth Low Section 4291,7.
11L A chief fiscal otter of a county or a pubic admin$tretor apponted pursuant to the S rrogate's Court Procedure
Act;
10a. My other per ate who is wing on behalf sit the deceased and who has executed a to her.:Statement pu suent to
Pubic Health law Section 420^(r;.
For numbers 3.5 and'l above,by signirtg,the person(s)signing this Authorization,Form represent that they arc signing on detref of a
majority of the members of this mess of persons who are rcesonasiy available
ffr OS BOTM of fhe inAhwdngj
Woo hereby affirm that the body of the deceased dues not oon,uin a wry,battery per,Baer cell,radioactive implant
v or radioactive doviee and that any su;h reatenais were removed once to the execution of this Authorization Farm. failure
to remove these items prior to cremation may result in harm to the crematory and crematory torso,vial.
`—` lee*affirm that ineteiceons have boon given to Katie Mofehouse
Ome.t.many
mega erg the removal Or any personal prop(hry or cihor dew of mere which any person signing below or any family
member of the deceased wisps to prrserve. Pine View Crematory
retemertine
not responsible.Far the removal of personal dense from the container or front OW remains of the decease Personal
items left in the ooertainer or wlt h the remains will be destroyed by the cremation process and cannot be retrieved
after cremation.
;lnrhad OP?)O MAL)
—lMb hereby authorize the named funeraf director to provide for delivery to and cremation by en 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.
Name of deceased:Richard Gdason McSoadden,Jr
OOS'1898-f(Rev.0ei23) Page 2 of 3
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10/3723,2:16 PM Cremation of RG McSpadden 4.jpeg
Authorization for Cremation and Disposition
FINAL l SPOSMON
The Mal resting puce for the cremated remains of Vie deceased is
®f taoement in al grave,crypt,or niche.at
-- - - ____
rcrmeb7 esa,nnr
El Scatter n9 as permitted by raw
El Other Given to Julia McSpadden «.. f- !1 y
taro
The person authorized to receive the cremated remains of the deceased frrxr.the demote',.,i
Katie Morehouse 82 Broadway,Fat Fdward NY 12828 518-747-9'266
.0461 ;6eui
/ M M ;authorize the tuneral directx executing this Autterzahcn Fenn,whose name appears o^,page 2 of this form.to receive
�t' of send a representative of his or ner runt rim In receive the crenated zrmams On nryjcur bohatf.
if for any reason Me person.mined above does not sum Vision of the cremated remains.
Pine View Crematory
....._ __... ....._is euirionzed to give i
AYcia m,Iti•mq 3 possession o_
the cremated remains to
M.S.Kimer Funeral Home
;Faae nrn;.+Mn,ut
,.--
in person or via delivery by tine Untied Slates Postal Service,ax permitted by its regulations arid procedures.
(Wier the foaming)
trWe understand that if the rernairr:are net carried wilirin 122 days of err r,aaen.
Pine View Crematory
_ _—
may dose of the remain man irretrievable manner,as permitted(pi aw.
This Authorization Form was Provided by Katie Morehouse wr_osec;2ed at
M.R.Kilmer Funeral Home
82 Broadway,Fat Edward NY 12828
roretia!htillrrlrs.ncr
.
art is Signed by the funeral director es y rtress to its execution
wire have received a completed copy of tins Authorization Form.
LIWe emfare the personas}In Control of disposition,who by signing this Authorri o tlon Form,attestts)to the accuracy and
comple lanes of the information cosiained In this Authorization Form and horrrby authorise(*)to cremate the mmains of the
deceased.
Signed this 3rd day of October .20 23_
Julia McSpeddt } w 11.1 C� �
rrroadorHlkrrrr .. _..-. .. —
•
8417 Pine Bluff Road,Frederick MD 21704
Adtlicua
rypardr.icwuirwm. _— iA IOr _...
WITNESS:
. f
Katie Morehouse r• ill ,i... "`
An,..c .ryirrarnvmrra s
.V: .1.,tiambes -
14931
Name of d Richard Gibson McSpadden,McSpadden,Jr
DOS-1898-(Rev.08123) Page 3 of 3
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