Connor, Michael NEW YORK CITY THE CITY OF NEW YORK-DEPARTMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE APRIL 07,2016 02:23 AM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-16-014929
EVENT:(CHECK ONLY ONE) N DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFICATE NUMBER
NAME First,Middle,Last AGE I SEX DATE MONTH DAY YEAR
OF (YYm
Michael Connor 64 Male EVENT 1 04 04 2016
PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
EVENT NEW YORK CITY
Brookl n New York Methodist Hospital
CERTIFIER
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD 9 INTERMENT ❑ CREMATION CREMATION APPROVED BY:
OF MEIMLI
Adnan Raza DISPOSAL ❑ OTHER M.E.CASE#
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY Y(YEYAYR)
DISPOSITION OF
Shaaray Tefila Cemetery Queensbury, NY DISPOsmON 04 11 2016
THE CERTIFICATE OF DEATH HAVING BEEN FILED AS REQUIRED BY THE HEALTH CODE,AND ALL LAWS AND REGULATIONS
GOVERNING THE PREPARATION AND DISPOSAL OF HUMAN REMAINS HAVING BEEN COMPLIED WITH, PERMISSION IS
HEREBY REQUESTED TO DISPOSE OF THE REMAINS AS IDENTIFIED ABOVE.
FUNERAL NAME OF ESTABLISHMENT ADDRESS CITY AND STATE N.Y.STATE REG.#
ESTABLISHMENT Riverdale Funeral Home 1 5044 Broadway New York, New York 01475
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
Nicholas G.Apostle I �uyWZ�Mc",ElectronicallyAuUmficated 10097
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE R EQUES BOVE.?
NOTICE: This permit is not valid without the seal of the Department =°�•'� �-:,•y.
of Health and Mental Hygiene;or if it has been corrected, : .?
interlined or altered in an <�_ '�
Y manner. •. �.� Gty Registrar
VR21(REV.7/09) FEE PAID$40.00 DATE 04 / 07 /2016 •�����.,* By Kathiravelu Kailayanathan
MM DD VYYY Q11 OF N t