Baumann, Christopher 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 24,2020 12:25 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-20-034735
EVENT:(CHECK ONLY ONE) Jg DEATH El SPONTANEOUS TERMINATION ❑INDUCED TERMINATION --""" CERTIFICATE iNUMBER
NAME First,Middle,Last AGE SEX DATE MONTH DAY YEAR
OF (YYYY
Christopher Baumann 58 Male I EVENT 04 18 202
PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
EVENT NEW YORK CITY
Manhattan Mount Sinai St. Luke's
CERTIFIER METHOD ❑ INTERMENT X CREMATION
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY:
OF ME/MLI Kristin Roman
Jason Dietz DISPOSAL ❑ OTHER M.E.CASE k M20022807
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
DISPOSITION OF (YYYY)
Pineview Crematory Queensbury, NY DISPOSITION 04 25 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 ESTABLISHME ADDRESS CITY AND STATE N.Y.STATE AEG.#
ESTABLISHMENT New Leaf Cremation 3930 Long Beach Rd Island Park NY 02058
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
Michael Noll cwsc�°r Si9naNmEb 11iwlty Auftnfiatedj 14105
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, A.
interlined or altered in any manner. Cry Registrar
VR 21(REV.7/09) FEE PAID$40.00 DATE 04 22 /2020 ' •�; ••'* By Sen!ic e_Evital
MM DD YYYY
New Leaf Cremation +
Baumann, Christopher
TR042520_FH11/CO5/032
Public Health Law Sec. 4145(2b) j 13 6 27
Receipt
Human remains of delivered on , 20_
Pine View Cemetery Representing the'funeral home named on burial permit
Official Funeral Directors Reg.or License#