Wainwright,Alpheus 46 8
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 28,2020 07:00 PM 156-20-037456
EVENT:(CHECK ONLY ONE) ®DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFICATE NUMBER
NAME First,Middle,Last AGE I SEX I DATE MONTH DAY YEAR)
OF
Alpheus Wainwright 60 Male EVENT 04 22 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Brooklyn Wyckoff Heights Medical Center
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY:
CERTIFIER METOFOD U INTERMENT Af( CREMATION r 0 ME/MLI Kara Storck
Sl
Hussam Sawass DISPOSAL OTHER M.E.CASE#K20024579
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF YYYY)
DISPOSITION Pine View Crematorium Queensbury,New York 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.
NAME OF ESTABLISHMENT ADDRESS CITY AND STATE N.Y.STATE AEG.#
FUNERAL
ESTABLISHMENT House of Hills, Inc. 1000 Saint Johns PI Brooklyn NY 00805
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) S ATU N.Y.STATE LIC.#
APPLICANT Vim",
Charise Hill-Wilkins A.111.ticated 11621
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE. /
NOTICE: This permit is not valid without the seal of the Department ~�!s•••• y� 'U/ i��,
of Health and Mental Hygiene;or if it has been corrected, • • �i a/� ,j��
interlined or altered in any manner. City Registrar
VR 21(REV.7/09) FEE PAID$40.00 DATE 04 / 28 /2020 i:; ." L; By_Service_Evital
MM DD YYYY •••
�t7f N0�
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
f
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#