Schrader, Corina IV f
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 17,2020 07:24 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-20-029717
EVENT:(CHECK ONLY ONE) M DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION - CERTIFICATE NUMBER
NAME First,Middle,Last AGE I SEX I DATE I MONTH DAY YEAR
OF (YYYY)
Corina Schrader 93 Female EVENT 04 13 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Queens Margaret Tietz Nursing & Rehabilitation Center
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY:
CERTIFIER METHOD ❑ INTERMENT �CREMATION
OF ME,MLI Anne Laib
David Tavdy DISPOSAL ❑ OTHER M.E.CASE I Q20019681
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF (YYYY)DISPOSITION 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 11!17i7��
svmll �=calkypWW�W 13073
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE QUESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department
of Health and Mental Hygiene;or if it has been corrected, 0 _ Ad
interlined or altered in any manner. 01 Cry Registrar
VR 21(REV.7/09) FEE PAID$40.00 DATE 04 ) 17 /2020 %00. ' By Service Evital
MM DIDYYYY �•.".fsNE!
Public Health Law Sec. 4145(lb) 0
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#