Atalay, Martha E. ,11- 46 (
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 27,2020 01:00 PM 156-20-036475
EVENT:(CHECK ONLY ONE) ®DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION - cEaTiFicnTe riiiMaea
NAME First,Middle,Last AGE SEX DATE MONTH DAY YEAR
OF
Martha E Atalay 95 1 Female EVENT 04 26 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW PORK CITY
EVENT Queens 8071 Grenfell St, Kew Gardens, NY 11415-1023
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY:
CERTIFIER METHOD ❑ INTERMENT CREMATION
OF MElMLI Ian Bautista
Lucinda Langenkamp DISPOSAL ❑ OTHER M.E.CASE# Q20024094
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
DISPOSITION OF
Pine View Crematory Queensbury, NY DISPOSITION 04 29 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 TAD.DRESS CITY AND STATE N.Y.STATE REG.#
ESTABLISHMENT Fox Funeral Home, Inc. 07 Ascan Ave Forest Hills NY 00603
APPLICANT
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE - N.Y.STATE LTC.
('
Steven Duca Signature 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 ?`� `'"`+!•� `
of Health and Mental Hygiene;or if it has been corrected, �• •s Y Q�
interlined or altered in any manner. City Registrar
VR 21(REV.7/09) FEE PAID$ 40.00 DATE 04 / 27 /2020 •• . • * By Service_EvitaI
MM DD YYYY •�• y
�'OF 4L`N
ublic Health Law Sec. 4145(2b) 01- 3 6 5 4
.eceipt
[uman remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
official Funeral Directors Reg.or License# y