Schoen, Edward . 0 , '�' 4Z�
NEW YORK CITY THE CITY OF NEW YORK—DEPARTMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
April 22,2020 03:55 PM 156-20-033372
EVENT:(CHECK ONLY ONE) ®DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFICATE NUMBER
First,Middle,Last AGE SEX DATE MONTH DAY YEAR
NAME OF
Edward Schoen 65 Male I EVENT 04 21 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Queens 8403 Doran Ave,Glendale, NY 11385-7731
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT CREMATION r CREMATION APPROVED BY:
CERTIFIER OF 1 MF�MLI Yvonne Milewski
- Sean Kelly
DISPOSAL ❑ OTHER M.E.CASE#Q20021883
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
(Y YY)
OF
DISPOSITION Pine View Crematory Queensbury,NY DISPOSITION 04 24 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 Fox Funeral Home, Inc. 9807 Ascan Ave Forest Hills NY 00603
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGN N.Y.STATE LIC.#
APPLICANT
Steven Duca u Signature Electronically Authenticated 14007
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department �:••••o•��
of Health and Mental Hygiene;or if it has been corrected, •
interlined or altered in any manner. Cly RegMrar
VR21(REV.7/09) FEE PAID$ 40.00 DATE 04 / 22 /2020 '•• • « By_Serv--ice Ev-ital
MM DD YYYY �'oFr �
Public Health Law Sec. 4145(2b) 13 6 -
.aR g..
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# `