Stephenson, Deborah C LOWN OF QUEEVBURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director �� EAR A� 11 E kZ—
Name 0,1 fl, t"PiO ke O14- Case #
Date of Cremation C)CjC)
Time Cremation Started \ ti to S A
Time Cremation Completed _ A � f Nl,
Type of Container o Ke c�
Remarks :
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TOWN OF QUEENSBURY �
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 745-4477 (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:
Deborah C. Stephenson Female
(NAME) (SEX)
819 Schroon River Rd. , Warrensburg, NY 12885
(STREET) (CITY) (STATE) (ZIP CODE)
who died on 29th day of Dec. )2& 1999
at her home (Same as above)
(PLACE) (ADDRESS)
Name and address of nearest living relative or name of person authorizing cremation:
Larry Stephenson, 819 Schroon River Rd. , Warrersh„r�z, NY 12885
Relationship to deceased Husband
Name of Funeral Home Alexander FH, Warrensburg, NY
IMPORTANT
I represent that to the best of my knowledge, the deceased has or as no acemaker 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 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
ag ins1 m by reason of or connected with the cremation of said remains as directed, whether
such clai s or demands are or are not wholly groundless, false or fraudulent.
Warrensburg, NY
(WI ESS) (ADDRESS)
�f Same as above
(SIGNATURE OF RELATIVE OR LEGAL REP. AND ADDRESS)
Signed on this date: 12-29-99