Tortoroli, Andree NEW YORK CITY THE CITY OF NEW YORK—DEPARTMENT OF HEALTH AND MENTAL HYGIENE 4
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
April 27,2020 01:55 PM 156-20-036512
EVENT:(CHECK ONLY ONE) N DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION -------------
NAME riiiMeeR
First,Middle,Last AGE SEX I DATE I MONTH DAY YEAR
OF (YYYY)
Andree Tortoroli 86 1 Female EVENT 04 26 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW PORK CITY
EVENT Queens Forest View Center for Rehabilitation&Nursing
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY:
OF ME/MLI
CERTIFIER METHOD ❑ INTERMENT i� CREMATION Joseph Pestaner
Kevork George Boyadjian DISPOSAL ❑ OTHER M.E.CASE#Q20024130
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF (YYYY)
DISPOSITION 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 ADDRESS CITY AND STATE N.Y.STATE REG.#
ESTABLISHMENT Fox Funeral Home, Inc. 9807 Ascan Ave Forest Hills NY 00603
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) '�S JXTUaj/�� N.Y.STATE LIC.#
Thaddeus W. Baxter a i IlyAuthenbcated 10227
PERMISSION IS HEREBY GRANTED TO DISPOSE OF TH' 3E UESTED ABOVE. v
NOTICE: This permit is not valid without the seal of the Department
of Health and Mental Hygiene;or if it has been corrected, •sx �� Q�
interlined or altered in any manner. i Cry Registrar
• •
VR21(REV.7/09) FEE PAID$ 40.00 DATE 04 ) 27 i2020 '*0 �00* By_Service Evital
MM DID YYYY �'OfNEv'1�
Public Health Law Sec. 4145(2b) 013670
Receipt
Human remains of delivered on p ' ` , 20
i {
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#