Naraine, Khemraj 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 12:20 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-20-034723
EVENT:(CHECK ONLY ONE) 19 DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION - "' C RTIFI-ATE NUMBER
--" "'
CERTIFICATE
NAME First,Middle,Last AGE SEX DATE MONTH DAY YEAR
OF (YYYY)
Khemraj Naraine 64 Male EVENT 04 19 2020
PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
EVENT NEW YORK CITY
Queens St. John's Episcopal Hospital
CERTIFIER
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT X CREMATION CREMATION APPROVED BY:
OF ME/MLI Ian Bautista
Attia Hussain DISPOSAL ❑ OTHER M.E.CASE#Q20022806
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
DISPOSITION OF (YYYY)
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 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 Sig-W,EWtl niwllVAuftnbl ted 14105
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE,
NOTICE: This permit is not valid without the seal of the Department 4F1�.'� ��:�i
of Health and Mental Hygiene;or if it has been corrected, •
interlined or altered in any manner. 019 Cep Registrar
VR 21(REV.7/09) FEE PAID$40.00 DATE 04 ( 22 (2020 ' .�, 0 By Service Evital
MM DD YYYY Cy�yD!NY
New Leaf Cremation
Naraine, Khemraj
TR042520_FH11/CO5/031
1
Public Health Law Sec. 4145(2b). 0 --3 J 0
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#