Wangel, Tenje 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 15,2020 08:24 PM 156-20-027771
EVENT:(CHECK ONLY ONE) N DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFICATE NUMBER
NAME First,Middle,Last AGE SEX I DATE I MONTH DAY YEAR
OF (YYYY)
Ten'e Wan el 77 Male EVENT 04 07 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW PORK CITY
EVENT Brooklyn Woodhull Medical and Mental Health Center
CERTIFIER
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT CREMATION
CREMATION APPROVED BY:
®
OF ME/MLI Jay Stahl-Herz
Su M Aye DISPOSAL ❑ OTHER M.E.CASE K20015326
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
DISPOSITION OF (�)
Pineview Crematory Queensbury, New York DISPOSITION 04 16 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.
FUNERAL NAME OF ESTABLISHMENT ADDRESS CITY 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.#
Nicholas A. Cassese W-= . SI na Authenticated 10582
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE. v
NOTICE: This permit is not valid without the seal of the Department •,r • r
of Health and Mental Hygiene;or if it has been corrected, �•'' ` • Y QI� f
interlined or altered in any manner. ' Cry Registrar
VR 21(REV.7/09) FEE PAID$ 40.00 DATE 04 / 09 /2020 ' ••. ; By Service_Ev_ital
MM DD YYYY 4�. N fp;'t
-No` 71) f%Z y, �02�
Public Health Law Sec. 4145(2b) 013 5 68
Receipt
Human remains of delivered on , 20_
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#