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Guzman, Maurilio
t�z-7 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 16, 2020 03:54 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS 156-20-028441 EVENT:(CHECK ONLY ONE) X DEATH ElSPONTANEOUS TERMINATION ElINDUCED TERMINATION CERTIFICATE NUMBER __ NAME First,Middle,Last AGE I SEX I DATE MONTH DAY YEAR OF (Y� Maurilio Guzman 55 Male EVENT 104 07 2020 PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS EVENT NEW YORK CITY Queens Elmhurst Hospital Center CERTIFIER NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT CREMATION CREMATION APPROVED BY: � OF ME/MLI Melanie Gutteea Joseph Lieber DISPOSAL ❑ OTHER M.E.CASE#Q20019382 PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE T04 DAY YEAR DISPOSITION OF (Y� Pineview Crematory Queensbury, New York DISPOSITION 18 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 FUNERAL N.Y.STATE REG.# 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. Rodri uez ©'n°a E Sigt 13073 neve legronkaly AUhentMatep PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE. NOTICE: This permit is not valid without the seal of the Department a• s of Health and Mental Hygiene;or if it has been corrected, • interlined or altered in any manner. Cry Regirar VR 21(REV.gyros) FEE PAID$40.00 DATE 04 / 17 )2020 •• o • By Service Evital MM DIDYYYY Cyn,OFN J oLj1 Za_F( t Public Health Law Sec. 4145(2b)` 13 6 1 Receipt t Human remains of delivered on , 20_ f Pirie View Cemetery Representing the funeral home named on burial.permit Official Funeral Directors Reg.or License#