Loading...
Guanaquiza, Segundo M - �'t 7 NEW YORK CITY THE CITY OF NEW YORK—DEPART*ENT OF HEALTH AND MENTAL HYGIENE DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS AND MENTAL HYGIENE April 15,2020 12.54 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS 156-20-027244 EVENT:(CHECK ONLY ONE) M DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFICATE NUMBER NAME First,Middle,Last AGE I SEX I DATE I MONTH DAY YEYARY) OF Segundo Guana uiza 56 Male EVENT 04 07 2020 BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS PLACE OF NEW PORK CITY EVENT Queens 4138 Case St, Apt 3A, Elmhurst, NY 11373-2204 NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT CREMATION APPROVED BY: CERTIFIER �CREMATION OF ME/MU Jeremy Stuelpnagel Amanda Krausert DISPOSAL ❑ OTHER M.E.CASE n Q20013590 PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR YY ) 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. FUNERAL NAME OF ESTABLISHMENT ADDRESS rEhm Y AND STATE N.Y.STATE REG.# ESTABLISHMENT Gerard J. Neufeld, Inc. 8804 43rd Ave hurst NY 00661 APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.# Omar J. Rodriguez ©M-a 8gmll Elecl,oniraIHANhenticatW 13073 PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE QUESTED ABOVE. / NOTICE: This permit is not valid without the seal of the Department .: �`���i�5 of Health and Mental Hygiene;or if it has been corrected, 12 interlined or altered in any manner. Cry Regirar VR 21(REV.7/09) FEE PAID$40.00 DATE 04 / 15 /2020 By Service Evital MM DID YYYY DFNE�'"� CVN or w '-Pal se�ti �.og th 2\ lr e I ors Hera Reg 0r r -tic,40 1% b .\