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Pachay, Olga a # 3CL 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 16,2020 08:24 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS 156-20-028805 EVENT:(CHECK ONLY ONE) 19 DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFICATE NUMBER NAME First,Middle,Last AGE I SEX I DATE MONTH DAY YEAR OF Olga Pachay 85 Female EVENT 104 07 2020 BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS PLACE OF NEW YORK CITY EVENT Queens Long Island Jewish Forest Hills CERTIFIER NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT X CREMATION CREMATION APPROVED BY: OF ME/MLI Melanie Gutteea Bryan John Tran DISPOSAL ❑ OTHER M.E.CASE#Q20019198 PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY � DISPOSITION OF Pineview Crematory 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. NAME OF ESTABLISHMENT ADDRESS CITY AND STATE N.Y.STATE REG.# FUNERAL ESTABLISHMENT Gerard J. Neufeld, Inc. 8804 43rd Ave Elmhurst NY 00661 APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.# Omar J. Rodriguez I © s 13073 9newre�eermraiN n�nemmeietl PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE QUESTED ABOVE.NOTICE: This permit is not valid without the seal of the Department �.!,••"`" "'••,�. � Q� of Health and Mental Hygiene;or if it has been corrected, interlined or altered in any manner. Cry Registrar a• .? VR 21(REV.7/09) FEE PAID$40.00 DATE 04 ) 16 /2020 %•� By Service Evital MM DD YYYY '� �OF NVN Public Health Law Sec. 4145�2b) Receipt Human remains of delivered on , 20 r Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#