Jean-baptiste, Nadine 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 25,2020 11:05 AM 156-20-035383
EVENT:(CHECK ONLY ONE) N DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFICATE NUMBER
NAME First,Middle,Last AGE SEX DATE MONTH DAY YEAR
OF (YYYY)
Nadine Jean-baptiste 49 Female EVENT 1 04 25 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Brooklyn 436 New York Ave,Apt E6, Brooklyn,NY 11225-3242
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY:
CERTIFIER METOFOD ❑ INTERMENT ® CREMATION ME/MLI Jason Graham
Michelle Stram DISPOSAL ❑ OTHER M.E.CASE#K20023372
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
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SjG ATU J J J N.Y.STATE LIC.#
APPLICANT lT//�
Christopher Doria �ina ectronicallyAuthenficatedl 10987
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department ��;<•"' 0 deli„
of Health and Mental Hygiene;or if it has been corrected, • 0 Tf'�'!
interlined or altered in any manner. Z; Cly Registrar
VR21(REV.7/09) FEE PAID$ 40.00 DATE 04 / 28 /2020 .. . �. By Service Ev_ital
MM DID YYYY
• Y
,,olic Health Law Sec. 4145(2b) 01 3 6 E
Receipt
Human remains of delivered on , 20_
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#