Stever, M. Elizabeth �oWN OF QUEEN5BU-Ry
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name / /Ei-,/ Case #
Date of Cremation
Time Cremation Started `I',r'gH )9/M
Time Cremation Completedr � �M r
Type of Container
Remarks :
4
TOWN OF QUEENSBURY
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 745-4477 or 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:
M. Elizabeth Steuer female
(Name) (Sex)
343 Pettis Rd. Gansevoort NY 12831
(Street) (City) (State) (Zip Code)
who died on the 25th day of September year 2000
at Saratoga Hospital Saratoga Springs, NY
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
_ Rev Larry Steuer, 343 Pettis Rd. , Gansevoort, NY 12831
(Name) (Address)
Relationship to the deceased husband
Name of Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
I represent that tot est of my knowledge, the deceased has; or ^;-has Dno
pacemaker in his oKher body. (Circle One)
I certify that I have the full power and authorization to arrange for the crematirpn
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 against them
by reason of or connected with the cremation of said remains as directed,
w ether such claims or demands are not wholly groundless, false or fraudulent.
68 Main St, Hudson Falls, NY 12839
ss) (Address)
343 Pettis Rd, Gansevoort, NY 12831
(Signature of Relative or Legal Rep. and Address)
Signed on this date: %9-9/00