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Perez, Jose 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 10,2020 04:59 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS EVENT:(CHECK ONLY ONE) X DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION 156-20-022873 CERTIFlCATE NUMBER NAME First,Middle,Last AGE I SEX I DATE I MONTH DAY (Y� Jose Perez OF 65 Male EVENT 04 06 2020 PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS EVENT NEW PORK CITY Manhattan The Mount Sinai Hospital CERTIFIER NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD O INTERMENT CREMATION CREMATION APPROVED BY: � OF {MEIMLI Lauren Mecca Ruth Levy DISPOSAL ❑ OTHER 1\M.E.CASE x M20017159 PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR DISPOSITION Pineview Cremato OF (� rY Queensbury, New York DISPOSITION 04 18 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 Gerard J. Neufeld, Inc. 8804 43rd Ave Elmhurst NY 00661 APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) I SIGNATURE N.Y.STATE LIC.# Omar J. Rodriguez ©' d•�w .w 13073 PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE. NOTICE: This permit is not valid without the seal of the Department ��•' T, of Health and Mental Hygiene;or if it has been corrected, 0 interlined or altered in any manner. Cry Registrar • • VR 21(REV.7/09) FEE PAID$40.00 DATE 04 13 /2020 i•• �• ,* By Service Evital MM DD YYYY l030 Public Health Law Sec. 4145(2b) 9 9 1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#