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Rodney, Errol New Leaf Cremation-- Errol, Rodney NEW YORKSTATE DEPARTMENTOF HE TRO4252O_FH11/CO5/O3O Burial - Transit Permit Bureau of Vital Records Name First rvuauie -- — z -- Sex Errol Rodney Male Date of Death Age If Veteran of U.S.Armed Forces, 04/20/2020 69 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Hempstead Town Street Address The Five Towns Premier Rehabilitation&Nursing Center `p Manner of Death © Natural Cause Accident Homicide ❑Suicide ❑Undetermined Pending Circumstances Investigation WMedical Certifier Name Title Syed Kamal MD Address 1050 Central Avenue,Hempstead Town,New York 11598 Death Certificate Filed District Number Register Number City,Town or Village Hempstead 2950 ❑Burial Date Cemetery,Crematory or Facility Name 04/25/2020 Pineview Crematory Entombment Address 0 Cremation Queensbury Hamlet,New York ❑Donation z Removal Date Place Removed and/or —7and/or Held ~ Hold Address to LL Date Point of N Transportation Shipment (5 by Common Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home NEW LEAF CREMATION 02058 Address 3930 LONG BEACH RD., ISLAND PARK,New York 11558 Name of Funeral Firm Making Disposition or to Whom 1- Remains are Shipped,If Other than Above Address W (L Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/24/2020 Registrar of Vital Statistics ZCathCeen Murray(ECectronicaCCy Signed (signature) District Number 2950 Place Hempstead, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: rD Date of Disposition L o 2tJ`1� Place of Disposition V ^ w) le p" ,U (address) I (section) (i number/,, / (grave number) SName of Sexton or Person in C e re i s /G a "`''�"`� Z (p se print) 15 W Signature Title 2rN0 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) R " Receipt 1 Human remains of delivered on , 20 ' 1 f r Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#