Ladd, Marjorie Ruth NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Marjorie Ruth Ladd Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/06/2020 90 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
W▪ Manner of Death I:Natural Cause Accident 1:1Homicide Suicide ❑Undetermined ❑Pending
V Circumstances Investigation
Medical Certifier Name Title
G Diane Westbrook NP
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 568
▪Burial Date Cemetery,Crematory or Facility Name
11/10/2020 Pine View Crematory
Entombment Address
iCremation Queensbury,New York
❑Donation
O• ElRemoval Date Place Removed
and/or and/or Held
N Hold Address
0
a Date Point of
Cl) 11 Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
S2 Address
R
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/10/2020 Registrar of Vital Statistics join Pail Tranck(CtronicaY*nerl)
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F- 1
Z Date of Disposition UPI I 10 Place of Disposition
W
2 (address)
W
CO
CC (section) a(lot number) (grave number)
• Name of Sexton or Person in Charge of Pr mises t ���
Z (plea print)
W Signature Title � �
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
is
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#