Sanabria, Anna 5�
NEW YORK CITY THE CITY OF NEW YORK—DEPARTMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE
May 08,2020 10:21 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-20-042708
EVENT:(CHECK ONLY ONE) X DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERiiFicare riumsEa
NAME First,Middle,Last AGE SEX DATE MONTH DAY YEAR
OF (YYYY)
Anna Sanabria 71 ji Female EVENT 04 30 2020
PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
EVENT NEW PORK CITY
Bronx Lincoln Medical and Mental Health Center
CERTIFIER
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY:
METHOD J INTERMENT X CREMATION
OF ME/MLIAdrienne Licking
Chia Yu Chiu DISPOSAL 'J OTHER M.E.CASE#B20043081
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
(YYYY)
DISPOSITION Pineview Crematory Queensbury, NY DISPOSITION 105 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.
FUNERAL NAME OF ESTABLISHMENT ADDRESS CITY AND STATE N.V.STATE REG.#
,-
ESTABLISHMENT John J. Fox Funeral Home, Inc_(Bronx) 203 E 201 st St Bra, .>< NY 00897
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
Thomas Roemmelt c16mna66 mrnP Sq"tu®EbtronicW Autlrentic 13080
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE QUESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department �°�•' �-�•`y�
of Health and Mental Hygiene:or if it has been corrected, i1
interlined or altered in any manner. A�•; •�,•
• ;� City Registrar
VR 21(REV.7/09) FEE PAID$40.00 DATE 05 / 05 /2020 • •.•; By Serv_ic_e_E_vit_al
MM DD YYYY �'Of Nv'K
Public Health Law Sec. 4145(2b) - 0137 7 2
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named`on burial permit
Official Funeral Directors Reg.or License# ,'