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Cunningham,Granville H. NEWYORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit' Name First Middle Last Sex Granville H.Cunningham Male Date of Death Age If Veteran of U.S.Armed Forces, 05/03/2020 73 Years War or Dates F Place of Death Hospital,Institution or Z City,Town or Village Hempstead Town Street Address Nassau University Medical Center W Mannerof Death © W Natural Cause Accident ❑Homicide ❑Suicide Undetermined Pending U Circumstances Investigation WQ Medical Certifier Name Title Jaffer Ahmad MD Address 2201 Hempstead Tpke, Hempstead Town, New York 11554 Death Certificate Filed District Number Register Number City,Town or Village Hempstead 2950 Burial_ _ Date Cemetery,Crematory or Facility Name 05/11/2020 Pine View Cemetery and Crematorium Entombment Address Cremation Queensbury Town,New York Donation ORemoval Date Place Removed and/or and/or Held ~ Hold Address to O 0- Date Point of N Transportation Q by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home N F Walker Inc 01234 Address 2039 Merrick Avenue,Merrick Hamlet,New York 11566 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above Address cc W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/07/2020 Registrar of Vital Statistics ?Cathleen 94urray(Electronically Signer (signature) District Number 2950 Place Hempstead, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition S(t217,0 Place of Disposition {L &a'�` address) W N � /sedianJ 1 //at number/ /gra ve numbed a Name of Sexton or Person in Charge of Premises �^ � /p ase print/t) Z W Signature Title , DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) - 01� Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# ,