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Walfredo, Romero
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Walfredo Romero Male Date of Death Age If Veteran of U.S.Armed Forces, 05/01/2020 81 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Street Address 57 Brand Drive,Huntington,Huntington Town,New York 11743 Mannerof Death © Natural Cause Accident 1:1Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title G Trina Ogletree NP Address 99 Sunnyside Blvd,Woodbury Town,New York 11797 Death Certificate Filed District Number Register Number City,Town or Village Huntington 5153 ❑Burial Date Cemetery,Crematory or Facility Name 05/09/2020 Pine View Crematory Entombment Address iCremation Oueensbury Hamlet,New York ❑Donation Z Removal Date Place Removed F and/or and/or Held t- N Hold Address O d Date Point of N Transportation Shipment Q by Common Carrier Destination El Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home NEW LEAF CREMATION 02058 Address 3930 LONG BEACH RD., ISLAND PARK,New York 11558 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/08/2020 Registrar of Vital Statistics Andrew Wgia(`ElectronicaCCySigned) (signature) District Number 5153 Place Huntington, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H W Date of Disposition �—//— Z02y Place of Disposition 1 D lu (address) W (section) (iotnumber) (grave number) Name of Sexton or PersoA Chz of Premises I'+ 1 �: 'L (please print) W Signature A1,11Aalu Title DO H-1555(o7/18)p 1 of 013766 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 1 Pine View Cemetery Representing the funeral home named on burial permit 1 Official Funeral Directors Reg.or License#