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Docanto,Miriam NEW YORK CITY THE CITY OF NEW YORK—DEPARTMENT ORHEALTH AND MENTAL HYGIENE DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS AND MENTAL HYGIENE April 06,2020 02:08 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS 156-20-019047 EVENT:(CHECK ONLY ONE) 19 DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION _.__ CERTIFICATE NUMBER NAME First,Middle,Last AGE I SEX I DATE I MONTH DAY YEAR OF (YYYY) Miriam Docanto 50 Female EVENT 04 06 2020 PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS EVENT NEW YORK CITY Queens 10315 Otis Ave, Corona, NY 11368-4500 CERTIFIER NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT X CREMATION CREMATION APPROVED BY: OF ME/MLI Benjamin Criss Benjamin Criss DISPOSAL ❑ OTHER M.E.CASE#Q20012951 PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR OF (YYYY) DISPOSITION Pineview Crematory Queensbury, New York DISPOSITION 04 18 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 FUNERAL AND STATE N.Y.STATE REG.# ESTABLISHMENT Gerard J. Neufeld, Inc. 8804 43rd Ave Elmhurst NY 00661 APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.# Omar J. Rodriguez © sI.aa8..�yA M 13073 PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE. NOTICE: This permit is not valid without the seal of the Department �� !''!.•.yf of Health and Mental Hygiene;or if it has been corrected, • `'•z ���H Q/1� .� interlined or altered in any manner. 3,: ! Cry ReglSfrar VR 21(REV.7/09) FEE PAID$40.00 DATE 04 / 10 /2020 •� • By Flor Betancourt MM DO YYYY 4/yOFN£p;'� Public Health Law Sec. 4145(2b) 1213600 Receipt Human remains of delivered on , 20 i` Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#