Ladd, Henry NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
»:Name First Middle Last Sex
Henry Kendall Ladd Male
Date of Death Age If Veteran of U.S. Armed Forces,
October 29, 1997 79 War or Dates WW II
::::;:Place of Death Hospital, Institution or
illikagPfigg:Wor Village Hudson Falls Street Address 63 Boulevard
[::::Manner of Death Undetermined Pending
iliil ®Natural Causes❑Accident ❑ Homicide ❑ Suicide ❑ Circumstances ❑ Investigation
z€€Medical Certifier Name Title
Richard T. Hogan MD
Address
ei 325 Main Street, Hudson Falls, NY 12839
Death Certificate Filed District Number Register Number
iliiiitWiNaor Village Hudson Falls 5726 (5/c: —
Date Cemetery or Crematory
X❑ Burial October 31, 1997 Pine View Cemetery
❑ Cremation Address
Tn of Queensbury, NY
Date Place Removed
❑ Removal and/or held
and/or hold Address
Date Point of
❑ Transportation by Shipment
Common Carrier
Destination
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ Reinterment
:;::;Permit issued to Registration Number
':Name of Funeral Firm Carleton Funeral Home Inc. 00313
i Address
Nii P.O. Box 67, 68 Main St. , Hudson Falls, N.Y. 12839
iiiN 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 remains described above as indicated.
i>Date Issued /0..3/.07 Registrar of Vital Statistics % t. a4 —
(Signature
gg
5726 Hudson Falls, NY 12839
a District Number Place
'a
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of DispositionlO'731/97 Place of Disposition Pi ne View Cemetery ,Queensbury ,N1
(address)
Huron 9—D 1
(Section) (Lot Number) (Grave Number)
Name of Sext or erson in Charge of Premises Rodney G. Mosher
(Please Print)
Signature 6 --- 'r _ Title Superintendent
DOH-1555 (10/89) p. 1 of 2 VS-61