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Ostrander, Gary z - 7Oq+N OF QUEEN5BU9�y PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD. QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 EA Funeral Director { Name G,K V� ' "J Case # Iy Date of Cremation { { { — 4 ' Time Cremation Started 0 Time Cremation Completed © Type of Container � /OOCQ L✓�_/C� C) P Remarks : 4 1 f-4 30 5-0 n /2� C,O C - \mac; U-) N)i 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: Gary D. Ostrander II Male (Name) (Sex) 5 Prospect Street Warrensburg NY 12885 (Street) (City) (State) (Zip Code) who died on 15th day of November lg 99 at Little Falls Hospital Little Falls, New York (Place) (Address ) Name and address of nearest living relative or name of person authorizing cremation: Mrs Betty Engle 1548 Crest Dr. Englewood, Florida 34223 (Name) (Address) Relationship to the deceased mother Name of Funeral Home Alexander Funeral Home IMPORTANT: I represent that to the best of my knowledge, the deceased NdiPQHK has no pacemaker in hisXMV0 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 against them by reason of or connected with the cremation of said remains as dire�,ctecT; whether such claims or demands are or are not wholly ground le , false or fraudulent. C-J S0,44- tness ) (Address ) 9 Ae /I s OJvC- ( Si ature o elative or Legal Rep. and Address ) November 17, 1999 Signed on this date: