Cascon, Hirah Frias .. N66
NEW YORK CITY THE CITY OF NEW YORK x 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 12:45 PM 156-20-03645.4___
EVENT:(CHECK ONLY ONE) N DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION -------------
NAME First,Middle,Last AGE SEX DATE MONTH DAY YEAR
OF (YYYY)
Hirah Frias Cascon 67 Female EVENT 04 19 2020
PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
EVENT NEW PORK CITY
Queens 3962 65th PI, Woodside, NY 11377-3781
CERTIFIER
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT CREMATION
CREMATION APPROVED BY:
�
OF ME/MU Avneesh Gupta
Terra Cederroth DISPOSAL ❑ OTHER M.E.CASE# Q20020752
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
DISPOSITION OF (Ywv)
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) SIGNATURE N.Y.STATE LIC.#
[2
Thaddeus W. Baxter 2Q1yI nat Authenticated 10227
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE QUESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department ��•a� ��;�, �
of Health and Mental Hygiene;or if it has been corrected, o0
interlined or altered in any manner : City Registrar
VR 21(REV.7/09) FEE PAID$ 40.00 DATE 04 ) 27 1,2020 ' •• . ••�y' By Serv__ice_EvitaI
MM DD YYYY 4ryOFN
Public Health Law Sec. 4145(2b) 01 "�6 5
Receipt
Human remains of delivered on , 20_
t
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#