Driscoll,Joseph 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 12, 2020 11:09 AM _____ 156-20-024284
EVENT:(CHECK ONLY ONE) X DEATH ❑SPONTANEOUS TERMINATION El INDUCED TERMINATION CERTIFICATE NUMBER
NAME First,Middle,Last AGE I SEX I DATE MONTH DAY YEAR
OF (YYYY)
Joseph Driscoll 58 Male EVENT 04 10 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW PORK CITY
EVENT Queens 2543 42nd St, Bsmt,Astoria NY 11103-2805
CERTIFIER
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT CREMATION
CREMATION APPROVED BY:
]�
OF ME/MLI Jay Stahl-Herz
Jay Stahl-Herz DISPOSAL ❑ OTHER M.E.CASE# Q20015371
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
DISPOSITION OF (YYYY)
Pine View Crematory Queensbury, NY 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.
FUNERAL NAME OF ESTABLISHMENT ADDRESS CITY AND STATE N.Y.STATE REG.#
ESTABLISHMENT Fox Funeral Home, Inc. 1 9807 Ascan Ave Forest Hills NY 00603
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
APPLICANT
Steven Duca 1dMVMC/--JaMSignature Electronically Authenticated 14007
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE y QUESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department = 0� °'+,!•� `
of Health and Mental Hygiene;or if it has been corrected, • •< Q�
interlined or altered in any manner.
i%� City Registrar
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VR21(REV.7/09) FEE PAID$ 40.00 DATE 04 / 15 /2020 •• . •• By_Service_Ev_ital
MM DID
YYYY 'Of NE`N'�
Public Health Law Sec. 4145(2b) _~ p
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#