Copper, Barbara a _ J��gd
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 30, 2020 03:40 PM 156-20-038545
EVENT:(CHECK ONLY ONE) N DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION
NAME First,Middle,Last AGE SEX DATEToot
NTH DAY (YYYY)
OF
Barbara Copper 57 JFemale EVENT 2g 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Queens Hillside Manor Rehabilitation and Extended Care Center
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER `CREMATION APPROVED BY:
CERTIFIER METOD ❑ INTERMENT CREMATION OF J ME/MUKathleen Liggio
Sanjay Lodha DISPOSAL ❑ OTHER S`M.E.CASE# Q20039195
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF
DISPOSITION Pine View Crematory Queensbury, NY 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.
FUNERAL
NAME OF ESTABLISHMENT ADDRESS CITY AND STATE N.Y.STATE REG.#
ESTABLISHMENT Fox Funeral Home, Inc. 9807 Ascan Ave Forest Hills NY 00603
APPLICANT
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
Steven Duca (�{'(1i Signature EleclronicallyAuthenticated 1 14007
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
interlined or altered in any manner. I . Cry Registrar
VR21(REV.7109) FEE PAID$40.00 DATE 04 / 30 /2020 %001�0 By_Service_Ev_ital
Of NEt
• o. �
Public Health Law Sec. 4145(2b)
Receipt
Human remains of �11
delivered on , 2070
` I
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Pine View Cemetery Representing the funeral home named on burial ermit
Official Funeral Directors Reg.or License# i