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Morris, Donald NEW YORK STATE DEPARTMENT OF ACTH `�I. - Vital Records Section f IP� Burial - Transit Permit Name First Middle Last Sex Donald I. Morris Male Date of Death Age If Veteran of U.S. Armed Forces, 02/28/2011 86 War or Dates World War II Place of Death Hospital, Institution or) 7 A ° J'7 W City, Town or Village Chester Street Address Da ..cd o once Manner of Death j Natural Cause El Accident 0 Homicide Q Suicide Undetermined ❑ Pending t Circumstances Investigation W Medical Certifier Name n Title WILLIAM C. ORLUK, '7 D/ Address 6223 State Rte 9 Chestertown, NY 12817 Death ificate Filed Nu er Ci y, ow r Village (-//4?7e ," i' �6 2 J ❑Burial Date C-er tetery or Cr,emato 03/01/20116,-te 4 r) (! er/e.)tr/1e7 ,, ❑Entombment Address ©Cremation Ci.. A:a-7 X;,.° C.I R,./ -..-4rs1f ti p z In Removal Date Place Removed and/or Held and/or Address Hold U�► Date Point of a. ❑Transportation Shipment tli by Common Destination 0 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 t Remains are Shipped, If Other than Above 2 Address W — O. Permission is her y granted to dispose of the hu • •n r .ins described abo e as• icat Date Issued " ` R istrar of Vital Statistics\ � ,,. ca • . ure District Numbe5b 5 Place �� ,.� ,, .\� v W-P I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: t- uj uj Date of Disposition ao Place of Disposition AO t U sm w (address) 07 C (section) !� (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises l:+nn c.1 •� l�f`v n e�C z (please print) W Signature IAA, ,. Title c r.e v,-,a A-at y LAsS'l-- (over) DOH-1555 (02/2004)