Ramos, Margarito 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 12:15 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-20-034713
EVENT:(CHECK ONLY ONE) M DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION -----------cERriFicnTe NunaeeR
NAME First.Middle,Last AGE SEX DATE MONTH DAY YEAR
OF (YYYY)
Mar arito Ramos 65 Male EVENT 104 19 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Brooklyn Woodhull Medical and Mental Health Center
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT CREMATION CREMATION APPROVED BY:
CERTIFIER
OF �ME/MLI MaureenF Obrien
Spora Esunju DISPOSAL ❑ OTHER M.E.CASE#K20022804
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY (YYYY)
OF
DISPOSITION 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 ESTABLISHMENT ADDRESS CITY AND STATE N.Y.STATE REG,#
ESTABLISHMENT New Leaf Cremation 1 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 I cxul�ol Sig--Eb I—io lyANF—fiwtee 14105
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
of•!-•• y ��k�!'�d���''"'
NOTICE: This permit is not valid without the seal of the Department •!,` �!•?� y � ./'�of Health and Mental Hygiene;or if it has been corrected, • •
interlined or altered in any manner. City Registrar
VR 21(REV.7/09) FEE PAID s 40.00 DATE 04 / 22 /2020 '.•. •:' By Service Evital
MM DD YYYY OF N Y
New Leaf Cremation
Ramos, Margarito
TR042520_FH11/CO5/036
Public Health Law Sec. 4145(2b) -
Receipt
Human remains of delivered on 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#