Thompson, Nathaniel It qgg
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 27,2020 06:45 AM
156-20-036276
EVENT:(CHECK ONLY ONE) ®DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFICATE NUMBER
NAME First,Middle,Last AGE I SEX I DATE I MONTH DAY YEAR
OF (YYYY)
Nathaniel Thompson 80 Male EVENT 04 24 2020
PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
EVENT NEW YORK CITY
Brooklyn University Hospital of Brooklyn
CERTIFIER
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT CREMATION CREMATION APPROVED BY:
OF ME/MLI Michael Vaivao
Sophia Tribie DISPOSAL ❑ OTHER M.E.CASE# K20023647
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF (YYYY)
DISPOSITION Pine View Crematory Queensbury,New York DISPOSITION 05 01 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 Frank J.Barone Funeral Home 4502 Avenue D Brooklyn NY 00609
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SJGNATU J J J( '� N.Y.STATE LIC.#
Christopher Doria (IrJJ� nna e ectronicallyAuthenticated 10987
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE _ t UESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department �°•�� ��•� /,� /
of Health and Mental Hygiene;or if it has been corrected, •'
interlined or altered in any manner..
. v Clty Registrar
VR21(REV.7/09) FEE PAID$ 40.00 DATE 04 / 25 /2020 i•� �• * By_Service_Evital
MM DD YYYY 4�yOF N�yy
Public Health Law Sec. 4145(2b) J 13 6;8,
Receipt
Human remains of delivered on , 20
i
t
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
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