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Ladd Jr., Edward C Am- , , # 4CC NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Edward C Ladd Jr Male Date of Death Age If Veteran of U.S.Armed Forces, 08/04/2021 55 Years War or Dates Place of Death Hospital,Institution or 1Z City,Town or Village Johnson City Village Street Address United Health Services Hospital,Inc.-Wilson Medical Center Manner of Death ❑Natural Cause ©Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation l Medical Certifier Name Title O Teresa Sacco-Bedosky Coroner Address 60 Hawley Street,Binghamton,New York 13902 Death Certificate Filed District Number Register Number City,Town or Village Johnson City 0303 512 ❑Burial Date Cemetery,Crematory or Facility Name 08/09/2021 Pine View Crematory Entombment Address 1 Cremation Queensbury Town,New York ElDonation Removal Date Place Removed - and/or and/or Held I- Hold Address CO 0 ld. Date Point of to 11 Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 1. Remains are Shipped,If Other than Above ar- Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/09/2021 Registrar of Vital Statistics Maryann Kinne(ECectronicalty Signed) (signature) District Number 0303 Place Johnson City, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 17113174 Place of Disposition ettV W 2 /address/ W CO (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises grz;1LS / se print) Z W Signature Title az trpvt, DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 1 5 0 2 2 j Receipt 1 Human remains of '' & delivered on • , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#