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Ladd, Eric Timothy Sr.
(i r:\ NEW YORK STATE DEPARTMENT OF HEALTH —:" Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Eric Timothy Ladd Sr Male Date of Death Age If Veteran of U.S.Armed Forces, 08/14/2023 44 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Lake George Town Street Address 2011 New York State-9 Route 419,Lake George Town,New York 12845 Manner of Death Ei Natural Cause Accident Homicide Suicide I=IUndetermined Fel Pending Circumstances Investigation Medical Certifier Name Title Lynn Keil PA Address 1340 State Route 9,Lake George Town,New York 12845 Death Certificate Filed Town Of Lake George District Number Register Number City,Town or Village 5651 6 Burial Date Cemetery,Crematory or Facility Name 08/18/2023 Pine View Crematory _Entombment Address ©Cremation Queensbury,New York Donation 0 Z Date Place Removed ❑Removal and/or and/or Held Hold Address 0 O. Date Point of (A Transportation IS by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address 11 Re•interment 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 } Remains are Shipped,If Other than Above g Address d Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/18/2023 Registrar of Vital Statistics Patricia R,9Kc7(/'nney-Sc/iuster( 1Tectromcafty Signed) (signature) District Number 5651 Place Town Of Lake George I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition f/9-zaz 3 Place of Disposition P. 4 Q vie.„/ (fin A. •, iu a (address) ` W 2 (section) (lot n mber (grave number) Name of Sexton or Person in Charge of remises *I Ont� t� ��f (P Print/ II' Signature4/ Title DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 • Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# Town of Queensbury Certification of Cremation Pine View Cemetery and Crematory This certifies that the remains of: Eric Timothy Ladd Sr. were cremated on August 19 20 23 at the Pine View (Month) (Day) Crematorium, Queensbury,New York, and these are the cremated remains of said body. Date of Death August , 14 20 23 Age as (Month) (Day) Funeral Home Singleton,Sullivan,Potter Funeral Home Registered No. 659 (Autho ized Signature) PELKEY Lot No. 104 Address 3089 RT 9L, LAKE GEORGE NY 12845 (LF; Section No. Owner THERESA & SHAWN PELKEY Plot ONEIDA Date 1191Q7 A P P R O X . 33 Superficial ft. Location BOUNDED ON NORTH BY LYNCH, SOUTH BY PATH, EAST BY STEWART, WEST BY PATCH . Corner Posts Remarks NOTE : RESERVED FOR SANDRA LEE HERMANCE Deed No. (and changes) 3468 Payment Record PAID IN FULL 1/9/07 ( $550 . 00) Record of Interments 7'W6834-A_.� � � - 15- ISO#. .S-le i'l÷ : / 2 7 3 Ii2i Ladd- 9.i5.a> = S.��a3 erd Y s 1 fi Form No. 01 LADD (LF NAME Eric Timothy Ladd Sr. Age: 44 •- Lot Owner: Theresa & Shawn Pelkey Lot# Oneida 104 Grave# 3 Case: Urn Died: 8. 1 4.2 3 Interred: 9. 1 5.2 3 Funeral Home: Singleton Sullivan Potter Cemetery: Pine View