Biggs, Atwell Nelson NEW YORK CITY THE CITY OF NEW YORK—DEPARTMENT OF HEALTH AND MENTAL HYGIENE 43�
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE
March 12, 2020 04:19 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-20-011055
EVENT:(CHECK ONLY ONE) X DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION - CERTIFICATE NUMBER
NAME First,Middle,Last AGE I SEX I DATE MONTH DAY YEAR
OF (YYYY)
Atwell Nelson Biggs 82 Male EVENT 03 11 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Brooklyn 1680 Bedford Ave,Apt 14E, Brooklyn, NY 11225-2613
CERTIFIER NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT X CREMATION CREMATION APPROVED BY:
OF ME/MLI Andrea Coleman
Andrea Coleman DISPOSAL ❑ OTHER M.E.CASE a K20007181
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF (YYYY)
DISPOSITION Pineview Crematory 1 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 3930 Long Beach Rd Island Park NY 02058
APPLICANT
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
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Michael Noll cw&xu C/�OCG Sig.,Wr,Ekctmnic ll,Aulhenflwted 14105
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department f
x
of Health and Mental Hygiene;or if it has been corrected, i
interlined or altered in any manner. ' Cry Registrar
VR 21(REV.7/09) FEE PAID$40.00 DATE 04 / 23 /2020 � * By Kathiravelu Kailayanaths
NAM DD YYYY �OFN04
New Leaf Cremation
,r Biggs, Atwell
'032
T11042520_FH11/05/034
P
Public Health Law Sec. 4145(2b) 013629
Receipt
Human remains of delivered on , 20
1
Pine-View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
1