Bilodeau, Frances 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
May 08, 2020 04:06 PM 156-20-042544
EVENT:(CHECK ONLY ONE) N DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFICATE NUMBER
First,Middle,Last AGE SEX DATE MONTH DAY YEAR
NAME OF
Frances Bilodeau 83 Female EVENT 05 06 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Queens Queens Boulevard Extended Care
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY:
CERTIFIER METOD ❑ INTERMENT CREMATION OF ME/MLI Cheryl Luning
Kalpesh Amin DISPOSAL ❑ OTHER M.E.CASE# Q20042918
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY (Y�)
OF
DISPOSITION Pine View Crematory Queesnbury, New York DISPOSITION 05 11 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 Fox Funeral Home, Inc. 9807 Ascan Ave Forest Hills NY 00603
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) I SIGNATURE N.Y.STATE LIC.#
APPLICANT
Steven Duca V aCQj Signature Electronically Authenticated 14007
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
0
•••••
NOTICE: This permit is not valid without the seal of the Department =� ^'`` "`+.,•�•rT �/�f
of Health and Mental Hygiene;or if it has been corrected, • •< •�
interlined or altered in any manner : Cly Registrar
VR 21(REV.7109) FEE PAID$ 40.00 DATE 05 / 07 /2020 •q'n N v By Service_Ev_ital
MM DD
Public Health Law Sec. 4145(2b) 013775
Receipt
Human remains of delivered on , 20
Pine View Cemetery Represenfing the funeral home named on burial permit
Official Funeral Directors Reg.or License#IZ