Loading...
Basco,Rodolfo DEP NEWYORK STATE MENTOFHEALTH T Burial-Transit Permit Bureau of Vital Records Name First Middle Last Sex Rodolfo Basco Male Date of Death Age If Veteran of U.S.Armed Forces, 04/06/2020 74 Years War or Dates Place of Death Hospital,Institution or z City,Town or Village Huntin ton Town Street Address Huntington Hospital pManner of Death ®W Natural Cause MAccident Homicide Suicide ❑Undetermined ❑Pending U Circumstances Investigation WW Medical Certifier Name Title Christopher Anselmi MD Address 270 Park Ave,Huntington Town,New York 11743 Death Certificate Filed District Number Register Number City,Town or Village Huntin ton 5153 0802 Burial Date Cemetery,Crematory or Facility Name 04/11/2020 Pine View Crematory Entombment Address ©Cremation Queensbury Hamlet,New York Donation ZO❑Removal Date Place Removed F, and/or and/or Held N Hold Address O a Date Point of N❑Transportation b by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Fox Funeral Home Inc 00603 Address 98 07 Ascan Ave,Forest Hills,New York 11375 Name of Funeral Firm Making Disposition orto Whom F. Remains are Shipped,If Other than Above 2 Address X W o_ Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/09/2020 Registrar of Vital Statistics Andrew 4Roia(ECectronicaCCySigned) Wgnarure) District Number 5153 Place Huntington, New York I certify thatthe remains of the decedent identified above were disposed of in accordance with this permit on: Zq� W Date of Disposition f zotaceof Disposition P,.L r4j 2 (address) W N (senlon) I (lot umber) (grave number) SName of Sexton or Person in Charge of Premi$es �A * W / . r� 1p aseprinU Title Signature L//'/ DOH-1555(o7/18)p 1 of z Public Health Law Sec. 4145(2b) - 1 5 9,,T Receipt Human remains of ''- delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#