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Liu, Carol
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vita[Records Name First Middle Last Sex Carol Liu Female Date of Death Age If Veteran of U.S.Armed Forces, 04/22/2020 78 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Oyster Bay Town Street Address 150 South Street,Oyster Bay Town, New York 11771 p Manner of Death © Natural Cause 1:1Accident Homicide Suicide Undetermined Pending W Circumstances Investigation U W Medical Certifier Name Title 0 David Klein DO Address 45 18 Court Square 500,Long Island City,New York 11101 Death Certificate Filed District Number Register Number City,Town or Village Oyster Bay 2952 Burial Date Cemetery,Crematory or Facility Name 04/25/2020 Pineview Crematory Entombment Address DRI Cremation Queensbury Hamlet,New York Donation z Removal Date Place Removed and/or and/or Held N Hold Address �. Date Point of W ❑Transportation Shipment j5 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 orto Whom F. Remains are Shipped,If Other than Above Address W d Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/24/2020 Registrar of Vital Statistics PjchardLouis LaWarca(ECectronicaCCy Signed (signature) District Number 2952 Place Oyster Bay, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition `F- 9-2020 Place of Disposition ,,1 e- l" _7 IU (ad W i �Zarge (section) (lot number) (grave number) Name of Sexton or Pe on i of Premises r� "/ (pleaseprint) z ! W Signature — New Leaf Cremation Title Liu, Carol DOH-1555(o7/18)prof TR042520 FH11/CO5/O37 1 Public Health Law Sec. 4145(2b) 013626 I i Receipt i Human remains of delivered on , 20 Pine view Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#