Maharaj, Deonarine 4 .. 4�qcv
NEW YORK CITY THE CITY OF NEW YORK-�DEPARTMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
April 21, 2020 12:29 PM 156-20-032337
EVENT:(CHECK ONLY ONE) ®DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION -----------cEariFicnre ivuMeea
NAME First,Middle,Last AGE SEX DATE MONTH DAY YEAR
OF
Deonarine Maharaj 89 Male EVENT 04 19 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Queens The Grand Rehabilitation and Nursing at Queens
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT ® CREMATION CREMATION APPROVED BY:
CERTIFIER
OF ME/MLI Michael Vaivao
Bernard Abramovici DISPOSAL ❑ OTHER M.E.CASE# Q20021393
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF
DISPOSITION Pine View Crematory I Queensbury, NY DISPOSITION 04 22 2020
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.
NAME OF ESTABLISHMENT ADDRESS CITY AND STATE N.Y.STATE REG.#
FUNERAL
ESTABLISHMENT Fox Funeral Home, Inc. 9807 Ascan Ave Forest Hills NY 00603
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
APPLICANT
Steven Duca lGM SignatureElectronicaliyAuthenticated 1 14007
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department r`��"`` "`+.!•� ���1Y Q�
of Health and Mental Hygiene;or if it has been corrected, • • (��'�
interlined or altered in any manner. : �" Cry Registrar
VR 21(REV.7/09) FEE PAID$ 40.00 DATE 04 / DO
/2020 NeN��k By_Service
1 _Ev ital
aw
Public Health Law Sec. 4145(2b) 0 1 ?5 9 4
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing tfie funeral ho'ine named on burial permit
Official Funeral Directors Reg.or License#