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Sutradhar, Berendra Chandra NEW YORKSTATE DEPARTMENT OF HEALTH N Bureau of Vital Records Burial - Transit Permi Name First Middle Last Sex Berendra Chandra Sutradhar Male Date of Death Age r1fVeteran of U.S.Armed Forces,04/20/2020 63 Years or Dates ZPlace of Death Hospital,Institution or W City,Town or Village Flower Hill Village Street Address St Francis Hospital-Roslyn p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation v WG Medical Certifier Name Title Bijan Zisman MD Address 100 Port Washington Blvd,Flower Hill Village,New York 11576 Death Certificate Filed District Number Register Number City,Town or Village Flower Hill Village 2975 255 Burial Date Cemetery,Crematory or Facility Name 04/25/2020 Pineview Crematory Entombment Address Cremation Queensbury Hamlet,New York ❑Donation Q❑Removal Date Place Removed H and/or and/or Held N Hold Address O 0. Date Point of (n Transportation p by Common Shipment 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 E— Remains are Shipped,If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/24/2020 Registrar of Vital Statistics W9nnieShatzkamer(ECectronicaCCySiyned) (signature) District Number 2975 Place Flower Hill Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H / W Date of Disposition �-'Z 7-'ZO20 Place of Disposition 7 ;->i 2 (address/ W N M (section) A number/ (grave number) Name of Sexton or Person' aK"11 f emises 1 ��G'�7 �N'��G�'t- W (Please print) Signature Title C t-e rv,% C' DOH-1555(07/18)p t of z Public Health Law Sec. 4145(2b) 013638 � Receipt Human remains of delivered on , 20 ,a' 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#