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Vetter, Jean NEW YORK STATE DEPARTMENT OF HEALTH -T{ a( J Vital Records Section ' . . _a Burial - Transit Permit Name First Middle Last Sex Jean J. Vetter Female Date of Death Age If Veteran of U.S.Armed Forces, 12/31/2010 85 War or Dates 1 Plac th Hospital, Institution or/6 A �Q� �/c' - 0 City To jr Village Chested Street Address Deceased's Residence G f, 7- 1.; W Manner of Death E Natural Cause 0 Accident Ei Homicide Ei Suicide 0Undetermined El Pending C Circumstances Investigation W Medical Certifier Name Title CI JOHN K. RUGGE, . 1r/_1) Address 3767 MAIN ST. Warrensburg, NY 12885 Death Certificate Filed District Numb er Register Number City,�owr br Village (,�)e.,S" 7 e c—• ��Z., 0 Burial Date cemterq or Cr tory .� ❑Entombment 01/03/2011 //fie v 6,) Cr,�,,,, �c,CjUGj Address 0/-eA 7 (/ 7))4 7�/©Cremation 7) //-?n• / ; Removal Date Place Removed z and/or and/or Held ri E Hold Address a Date Point of eL n Transportation Shipment CO by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00134 Address 9 Pine St/P.O. Box 455 Chestertown NY 12817 Name of Funeral Firm Making Disposition or to Whom #_ Remains are Shipped, If Other than Above 2 Address W a. Permission is herebygranted to dispose of the human r m p S d se ' ab a as indicated. Date Issued / o /// Registrar of Vital Statistics ' • 7 -y ��L' / - - , (signature) District Number (D5q Place /UYVN DF aNko reii I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition IC-^31 70(( Place of Disposition PI 0^ 6-01.2 P ru ���+ o n u,, W (address) V) IX (section) (lot number),,. (grave number) Q dJName of Sexton or Pe on in Charge Premisesr s�c)�h` PN.,t!{ Z (please print) W Signature ;M Title (12t=1h1i,04. (over) DOH-1555 (02/2004)