Cruz, Wanda NEW YORK CITY THE CITY OF NEW YORK-DEP —RIEMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE
April 24,2020 04:50 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-20-034962
EVENT: CHECK ONLY ONE)
) DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION ------------c1=RTiFicare niuMeea
NAME First,Middle,Last AGE I SEX DATE MONTH DAY YEAR)
OF
Wanda Cruz 51 Female EVENT 04 20 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Brooklyn Wyckoff Heights Medical Center
CERTIFIER
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD U INTERMENT X CREMATION CREMATION APPROVED BY:
OF j ME/Mu Carly Berdan
Karla Vargas DISPOSAL ❑ OTHER M.E.CASE K20023116
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF (YYYY)
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.
NAME OF ESTABLISHMENT ADDRESS CITY AND STATE N.Y.STATE REG.#
FUNERAL
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 I cwI�� Sly-mElam.iwiymmft bwWd 14105
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
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NOTICE: This permit is not valid without the seal of the Department �• q • 00,
of Health and Mental Hygiene;or if it has been corrected,
• !•F �
interlined or altered in any manner. City Registrar
VR 21(REV.7/09) FEE PAID$40.00 DATE 04 / 24 /2020 ' ••. By Serv_ice_Evital
MM DD YYYYOF Cy/yri 'i
New Leaf Cremation
Cruz,Wanda
TR042520_FH11/CO5/040
Public Health Law Sec. 4145(2b) -' •3' et
Receipt
Human remains of delivered on , 20
r
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#