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Cano, Reynaldo w3v NEW YORK CITY THE CITY OF NEW YORK-DEPARTMENT OF HEALTH AND MENTAL HYGIENE DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS AND MENTAL HYGIENE April 11,2020 09:59 AM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS 156-20-023364 EVENT:(CHECK ONLY ONE) X DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFICATE NUMBER NAME First,Middle,Last AGE SEX DATE MONTH DAY YEAR OF Reynaldo Cano 78 Male I EVENT 04 06 202, BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS PLACE OF NEW YORK CITY EVENT Queens Mount Sinai Queens CERTIFIER NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT CREMATION CREMATION APPROVED BY: OF MFJMLI Carla Devito Matthew Stephen Bremer DISPOSAL ❑ OTHER �MZCASE#Q200115846 PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY OF � YYY DISPOSITION Pineview Crematory Queensbury, New York DISPOSITION 104 202C 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.4. FUNERAL ESTABLISHMENT Gerard J. Neufeld, Inc. 8804 43rd Ave Elmhurst NY 00661 APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.# Omar J. Rodriguez © '� r .• .�r 13073 PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE 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, i' '•i ��+� �'�"' y Q/l� interlined or altered in any manner. g City Registrar VR 21(REV.7/09) FEE PAID$40.00 DATE 04 / 11 /2 � 00 rvice Evital MM DD 02 Cf.4 ��07/coc' 6998 Public Health Law Sec. 4145(2b) 013 6 2 4 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#