Duff, Fred I " 6 1
NEW YORK CITY THE CITY OF NEW YORK—DEPARTMENT OFF 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 09:05 PM 156-20-037518
EVENT:(CHECK ONLY ONE) ®DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION cEaTiFicarl=NunieEla
NAME First,Middle,Last AGE SEX DATE MONTH DAY YEAR
OF (YYYY)
Fred Duff 58 Male t EVENT 04 25 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Brooklyn Mount Sinai Brooklyn
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY'
CERTIFIER METHOD U INTERMENT Af[ CREMATION ME/MLI Adrienne Licking
OF
Samir Farhat DISPOSAL 'L) OTHER M.E.CASE#K20024589
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 REG.#
FUNERAL
ESTABLISHMENT House of Hills, Inc. 1000 Saint Johns PIBrooklyn NY 00805
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) S ATUI3E/GfXJ(/ - N.Y.STATE LIC.#
APPLICANT ((//(�//U�.��Gc _ ,(
Charise Hill-Wilkins J s re&ryAuth.ticawd 11621
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department ....
of Health and Mental Hygiene;or if it has been corrected, • •< ,
interlined or altered in any manner : a City Registrar
FEE PAID$40.00 DATE 04 / 27 (2020 '�•� . •� By_Service Ey_ital
VR 21(REV.7/09) MM DID v •• ,y
OF NeN
Public Health Law Sec. 4145(2b) 13 6`3 2
Receipt
Human remains of delivered on , 20
i
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#