Grevrekian, Eleanor rl-OTVN OF QUEENs5BU�KY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director ftf:1-kw\1 C6PX
Name _ IIn, 66/J)?,k1',9ACase # S 3 55--
Date of Cremation — 1 1 -- ZG Li Z
Time Cremation Started q 0 A -L-t
Time Cremation Completed ` ►" A
Type of Container G41za cogA- 'Z opte,
Remarks :
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TOWN OF:.1UE[=1VSBURY
PINE VIE+VV CEMETERY
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone(518):Crematpr tm 745-447.7 (if no answer)
Cemetery 7454476
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:
Eleanor L. Gevrekian Female
(NAME) (SEX)
Seven Heritage Lane, Bolton Landing, New York 12814
(STREET) (CITY) °; (STATE) (ZIP CODE)
who died on the 8th day'of December 2002
at Her Home on Heritage Lane, Bolton Landing, New York 12814
(PLACE) (ADDRESS)
Name and address of nearest living relative or name of person authorizing cremation:
Edward Gevrekian, Seven Heritage Lane, Bolton Landing, New York 12814
Relationship to deceased Husband
Name of Funeral Home Alexander Funeral Home, Inc. , Warrensburg, NY 12885
IMPORTANT
I represent that to the best of my knowledge, the deceased N@W has no pacemaker in her
body. (CIRCLE ONE)
I certify that I have the full power and authorization to arrange for the cremation of the remains anc
to direct the disposition of,the cremated remain.$, that any.persppal possessions have either been
removed or may be destroyed; and agree to;protect;defend.aqOsave harmless Pine View
Crematorium from any and all claims and demands for loss or dar>nages which may be made
Tsuch
them by reason of or connected with the cremation of said remains as directed, whether
aims or demands are or are not wholly groundless, false or fraudulent.
John S. Alexander, 3809 Main St. , Warrensburg, NY 12885
(WITNE ) (ADDRESS)
rd Gevrekian, Seven Heritage Lane, Bolton Landing, NY
(SIGNATURE OF R LATIVE OR LEGAL REP. AND ADDRESS) 12814
Signed on this date: i a 0
2 0 3k,