Weaver, Kim NEW YORK CITY THE CITY OF NEW YORK—DEPARTMENT OF HEALTH AND MENTAL HYGIENE �/►� 1
DEPARTMENT OF HEALTH OFFICErOFVaTgL RECORDS ( l
AND MENTAL HYGIENE
April 17, 2020 01:49 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-20-029308
EVENT:(CHECK ONLY ONE) )[DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION ------------ciRTiFicare NUINBER
NAME First,Middle,Last AGE I SEX DATE MONTH DAY (YYYY)
OF
Kim Weaver 57 Female EVENT 04 15 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Brooklyn Woodhull Medical and Mental Health Center
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY:
CERTIFIER METOFOD ❑ INTERMENT CREMATION ME/MLI Adrienne Grande
Akbar Hamid DISPOSAL ❑ OTHER M.E.CASE#K20019549
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY (YEAR
YYYY)
OF
DISPOSITION Pine View Cemetery and Crematorium 1 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 N. F. Walker Funeral Home, Inc. 2039 Merrick Ave Merrick NY 01234
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE J Eleaoni allynnnanewtoe N.Y.STATE LIC.#
Danford S. Baxter � �` SignaNre 10225
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department
. ••••• i
of Health and Mental Hygiene;or if it has been corrected,
interlined or FEE PAID any 40.00 manner. DATE 04 / 17 )2020 �• • , ' •�
�; City Registrar
'' :'
VR 21 (REV.7/09) B• ' • y Service Evital
—-----------------------
MM DD YYYY OF% `t
Public Health Law Sec. 4145(2b) 013 17 4
Receipt
Human remains of rt U delivered on , 20
Pine View Cemetery Representing the funeral home named on ri ermit
Official Funeral Directors Reg.or License#