Alger, Dorothea �O` +N OF QUEEVBU9 Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director/� -"C l4C/rx
Name •� `/i��1y�/7 ///�"' Case #
Date of Crematicn
Time Cremation Started
Time Cremation Completed f ,/
Type of Container AM Tj#lk- /,�X
Remarks :
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I
TOWN OF OUEENSSURY
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, im
accordance with and subject' to its Rules and Regulations to
cremate the remains of:
Dorothea M. Alger Female
(Name) __. (Sex)
3979 Main St. , Warrensburg, N.Y. 12885
(Street ) (City ) (State) ( Zip Code )
who died on 30Th. day of Dec. 19 98
at 3979 Main St. , Warrensburg, N.Y. 12885
(Place) (Address )
Name and address of nearest living relative or name of person
authorizing cremation :
kenneth C. Alger, 3979 Main St. , Warrensburg, N.Y. 12885
(Name ) (Address )
Relationship to the deceased Husband
Name of Funeral Home Alexander Funeral Home
IMPORTANT:
I represent that to the best of my knowledge, the deceased ftaxxxw
has no pacemaker in his or 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 eitner
been removed or may be destroyed, and agree to protect , defenc
and save harmless Pine View Crematorium from any and all clams
and demands for loss or damages which may be made against them c,,
reason of/or connected with the cremation of said remains as
di ted, whether such claims or demands are or are not wno : : ,
round a s,, Ise or fraudulent .
John Iexander, 3809 Main St. , Warrensburg, N.Y. 12885
(Witness ) (Address )
3979 Main St. , Warrensburg, N.Y. 12885
(Signature o4f%Relative or Legal Rep. and Address)
Signed on this date : Dec. 31, 1998