Overstrom, Lorita TOWN OF QUEENs5BU9�
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name = 4 1 / C a s e #t e 7 Q
Date of Crematicnr
Time Cremation Started d�� �/►1 r
Time Cremation Completed1C�'
Type of Container =-Z T&o6 9,0 oC✓y.��C/'/. ®��}j� ,l/
Remarks :
-i� 11
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,
accordance with and subject' to its Rules and Regulations to
cremate the remains of:
Lorita Overstrom Female
(Name) _-. __. (Se0
94 Ash Dr. Lake George, New York 12845
(Street ) (City) (Statte) ( Zip Code )
who died on the 23rd d a y of _ June 19 99
at Residence — 94 Ash Dr. ,=Lake George, NY 12845
(Place) (Address )
Name and address of nearest living relative or name of persc7
authorizing cremation :
Donald Overstrom 94 Ash Dr. , Lake George, NY 12845
(Name ) (Address)
Relationship to the deceased Husband
Name of Funeral Home Alexander Funeral Home 3809 Main St. , Warrensburg
NY 12885
IMPORTANT:
I represent that to the best of my knowledge, the deceased`� or
as n pacemaker in his or her body. (Circle One)
I certify that I have the full power and authorization to arrange
for the cremation of t'he remains and to direct the disposition cf
the cremated remains, that any personal " possessions have eitne*-
been removed or may be destroyed, and agree to protect , cefen
and save harmless Pine View Crematorium from any and all c ; a ' ,Ms
and demands for loss or damages which may be made against them
reason of or connected with the cremation of said remains as
di ecte , whether such claims or demands are or are not wnc : . .
groundl , false or fraudulent.
Jo Alexander 3809 Main St. , Warrensburg, NY 12885
(Witn��, � (Address)
94 Ash Dr. , Lake George, NY 12845
(Signature of Relative or Legal Rep. and Address)
Signed on this date : June 23, 1999