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Juarez, Santos Marroquin
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 15, 2020 12:39 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS 156-20-027228 EVENT:(CHECK ONLY ONE) X DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFICATE NUMBER NAME First,Middle,Last AGE I SEX DATE I MONTH DAY YEAR Santos Marro uin 'uarez 45 Male EVE Y EVENT 04 10 2020 PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS EVENT NEW YORK CITY Queens Elmhurst Hospital Center CERTIFIER NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT Jul M CREMATION CREMATION APPROVED BY: OF ME/MLI Dennis Cavalli Joseph Lieber DISPOSAL ❑ OTHER M.E.CASE#Q20018248 PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR (YYYY) DISPOSITION OF Pineview Crematory Queensbury, New York DISPOSITION 104 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. 1 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 © SV�1u El ,tyAUhentmW 13073 PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE QUESTED ABOVE. NOTICE: This permit is not valid without the seal of the Department °�' •:,:�r of Health and Mental Hygiene;or if it has been corrected, : interlined or altered in an • •� y manner. Cly Registrar VR 21(REV.7/09) FEE PAID$40.00 DATE 04 13 /2020 00 09 By Service Evital MM DO YYYY '�OF NL* Ral��Zi1-� �Co� b��) Public Health Law Sec. 4145(?!)j` 01_3 6 0 3 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#