Schrammel, Ladislaus Joseph k
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle 1 Last Sex
Ladislaus Joseph Schrammel Male
Date of Death Age If Veteran of . Armed Forces,
12/04/2020 75 Years War or Dates `.,,... _
Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death ❑X Natural Cause ❑Accident 1=1 Homicide ❑Suicide ❑Undetermined ❑Pending
UCircumstances Investigation
EMedical Certifier Name Title
LL1� Sean Bain MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 555
0 Burial Date Cemetery,Crematory or Facility Name
12/08/2020 Pine View Crematory
❑Entombment Address
gCremation Queensbury,New York
❑Donation
0 El Removal Date Place Removed
*-1- and/or and/or Held
H Hold Address
N
O
Q. 1-1 Date Point of
CO Li Transportation Shipment
p by Common
Carrier Destination
❑Disinterment
Date Cemetery Address
Date Cemetery Address
❑Reinterment
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
W
d` Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/08/2020 Registrar of Vital Statistics 2o6err,,Indiew Curtis(EYectronica115,Signed)
(signature/
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition rt IT i 70 Place of Disposition -c?..u,_ gka11
UJ
2 (address)
W
Q (section) // e1aoL__51s1(lot number) (grave number)
Name of Sexton or Person in Charge of remises fitZrint)
W Signature C— Title lliw/4ti-T e
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) L 014275
Receipt
Human remains of �. , delivered on , 20
Pine View Cemetery Representing the funeral home named on burial pe '
Official Funeral Directors Reg.or License#
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