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Harpp, Donna NEW YORK STATE DEPARTMENT OF HEALTH , A F I I U Vital Records Section Burial - Transit Permit Name First Middle Last Sex Donna J. Harpp Female Date of Death Age If Veteran of U.S. Armed Forces, 03/30/2011 67 War or Dates Place of Death Hospital, Institution or "�- ,-:12 r y „I //� A', W City, Town or Village Cheste► Street Address Deceased's Residence fua U Manner of Death X❑Natural Cause ❑ Accident 0 Homicide Q Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title CI SUZANNE M. RAYESKI, :2-)d Address 3767 Main St. Warrensburg, NY 12885 Deatp ificate Filed r-. � S. /fir District Number r j a Regi$ter Number City((Tow or Village Lp ❑Burial Date Citetery or Crematory�; ❑Entombment 03/30/2011 ✓ /Ili or,Crematory (_ �-?, i 04 cz,.. - Address�; , / �� A �� /� C©Cremation �v�r �Z.%7 jr� �:tG��J' ��'��l� Date Place Removed , • ❑ Removal• and/o and/or Held Hold Address O Date Point of nTransportation Shipment O by Common Destination 0 Carrier nDisinterment Date Cemetery Address 11 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 t Remains are Shipped, If Other than Above 2 Address W I' Permission is hereby granted to dispose of the ma emains descri. - . abo e as '.1.icated. Date IssuedZ-3b a01 . trar of Vital Statis 'v,,,,, . `.6\4s,It---.. (sig\: re) V-'\A' District Numbe6 1,NS a Place -�, �� -cN i ,L) ,.X&��I"1 I certify that the remains of the decedent identified above we isposed of in accordance with this permit on: WDate of Disposition 3-11-I Place of Disposition 'P/1,10 t r"v Ccv cc iou 2 (address) W U! ce (section) (lot number) (grave number) Qac,4001,., Sal❑ Name of Sexton or P rson in Chary of Premises !" t W " (please print) Signature Title C IhATort- (over) DOH-1555 (02/2004)