Ortiz, Luis ft-3$y
NEW YORK CITY THE CITY OF NEW YORK-DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Pe^' ENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE
April 15,2020 02:29 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-20-027338
EVENT:(CHECK ONLY ONE) X DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFICATE NUMBER
NAME First,Middle,Last AGE I SEX I DATE I MONTH DAY (Y�
OF
Luis Ortiz 47 Male EVENT 04 01 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW PORK CITY
EVENT Bronx North Central Bronx Hospital
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY:
CERTIFIER METOD ❑ INTERMENT OF CREMATION MEIMLI Lauren Mecca
Michela Faggioni DISPOSAL ❑ OTHER M.E.CASE#B2001 8286
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 AND STATE N.Y.STATE REG.#
FUNERAL
ESTABLISHMENT Gerard J. Neufeld, Inc. 8804 43rd Ave Elmhurst NY 00661
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
APPLICANT
Omar J. Rodriguez nzaa 13073
sremtua emrm�caiy nwxmre�ee
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE QUESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department .!�" "'`�!• fY Q��
of Health and Mental Hygiene;or if it has been corrected,
interlined or altered in any manner. ! t Cly Registrar
•
VR 21(REV.7/09) FEE PAID$40.00 DATE 04 / 13 /2020 ' •• ; By Service Evital
MM DD YYYY •�� 'y
Public Health Law Sec. 4145(2b) 013579
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#