Decker,Betty LO YVN OF QUEEVBU9 Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
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Date of Cremation
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TOWN OF QUEENSBURY
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone(518) CrerrtatQrium,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:
Betty Decker Female
(NAME) (SEX)
6 Townshed Road; Minerva, New York 12851
(STREET) (CITY) (STATE) (ZIP CODE)
who died on the 3rd day of December 2000
at the Glens. Falls. Hosptial —Glens Falls,. New York
(PLACE) (ADDRESS)
Name and address of nearest living relabve:or name of person authorizing cremation:
Mr. Merrill Dec?.er - 6 Tgv,mshed Rd. fiinerva, New York 12"51
Relationship to deceased- Husband.`
Name of Funeral Home Alexander Funeral Home, Inc. -
IMPORTANT
I represent that to the best of.my knowledge, the deceased baEW has no pacemaker in KNN)t 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
-- gainst them by reason of or,connected with the,cremation of said remains as directed, whether
uch claims or demands are or are not wholly groundless, false or fraudulent.
John S. Alexander .— 3809 Main St. , Warrensburg, NY 12885
(WITNESS) .(ADDRESS)
Oji 6 Townshed Rd. , Minerva, New York 12851
(SIGNATURE OF RELATIVE OR LEGAL REP. AND ADDRESS)
Signed on this date: 12/04/00