Ladd, Lla , t 10
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ha E. Ladd Female
Date of Death Age If Veteran of U.S. Armed Forces,
210 03/21/2013 88 years War or Dates
Place of Death Hospital, Institution or
itiCity, �r Saratoga Springs Street Address Saratoga Hospital
W Manner of Death jJ Natural Cause El Accident El Homicide ❑Suicide El Undetermined ri❑Pending
Circumstances Investigation
tu Medical Certifier Name Title
g Carlos A Ares Md
Address
59 Myrtle St., Saratoga Springs, N Y
Death Certificate Filed District Number Register Number
City, -1XXXX30(94ttat Saratoga Springs 4501 135
gi❑Burial Date Cemetery or Crematory
❑Entcmbcrsert 03/25/2013 • Pineview Crematorium
Address •
»;;;ECremation Queensbury N Y •
Date Place Removed
3 ❑Removal and/or Held
and/or
i; Address
CA Hold Address
q Date Point of
11 Or
in ransportation Shipment
Oi by Common Destination
Carrier •
Riii❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
111 Name of Funeral Home Densmore Funeral Home 0044$
Address
7 Sherman Ave, Corinth, New York 12822
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
iii
Permission is hereby granted to dispose of the human re ins de c a'',ed a'ir vee indica .
Date Issued 03/22/2013 Registrar of Vital Statistics
(signature)
District Number 4501 Place Saratoga Springs
Mi I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Itil Date of Disposition b-tto- Place of Disposition .X„,A1,0) �rvw4Or,,.J
2
ILEA (address)
ul
l (section) /1 (lot number) (grave number)
ct Name of Sexton or Per on in Charg of Premises `ir}xic, — c}„ti}
Z. (please print)
• Signature Title Ct2e,th 0E
(over)
DOH-1555 (02/2004)