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Barber, Chester i NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Chester H. Barber M Date of Death Age If Veteran of U.S. Armed Forces, January 20, 1998 71 War or Dates 1949-1969 Place of Death Hospital, Institution or City, Town or Village Saratoga Springs Street Address Saratoga Hospital Manner of Death Natural Cause Accident Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title W. Fisher MD Address 211 Church Street Saratoga Springs, NY 12866 Death Certificate Filed Saratoga Spring District Number 4501 Register j�l tuber City, Town or Village Date Cemetery or Crematory El Burial January 23, 1998 Pineview Crematorium Address NY 12804 ECremation Quaker Rd Queensbur y Date Place Removed 8❑Removal and/or Held •..• and/or Address Hold Q Date Point of Q Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Reggistration Number Name of Funeral Home Jillson Funeral Home, INC 01 006 Address 46 Williams Street Whitehall, NY 12887 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remain des ri ab i Date Issued 1 /21 /9 8 Registrar of Vital Statistics C�• (signature) District Number 4501 Place Public Safety Saratoga Springs, NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: z Date of Disposition/-07-5-17f Place of Disposition (address) Uj (section) lot number) ,pp (grave number) Name of Sextop or Person in Charge of Premisesin '�J4Jj4�D g (please print) s Signature Ale Title ':�f ©a S$ / DOH-1555 (10/89) p. 1 of 2 VS-61 r