Ramirez, rafaela NEW YORK CITY THE CITY OF NEV YOI(K—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 29,202012:30 PM 156-20-037741
EVENT:(CHECK ONLY ONE) ®DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION ------------cEenFicaTe NUMBER
NAME First,Middle,Last AGE SEX DATE MONTH DAY YEAR
OF (YYYY)
Rafaela Ramirez 82 1 Female I EVENT 04 27 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW PORK CITY
EVENT Bronx Calvary Hospital
NAME OF PHYSICIAN OR MEDICAL EXAMWER'S NUMBER CREMATION APPROVED BY:
CERTIFIER METHOD ❑ INTERMENT CREMATION OF ME/MLI Kristin Roman
Eric Cho DISPOSAL ❑ OTHER M.E.CASE# B20026734
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF (YYYY)
DISPOSITION Pineview Crematory Queensbury, New York 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 Schuyler Hill Funeral Home 1 3535 E Tremont Ave Bronx NY 01559
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) S ATURE J N.Y.STATE LIC.#
Jeannine Carbone (CatQ4re Electronically Authenticated 10534
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department : I�" �.0 00,
� 10 'i
of Health and Mental Hygiene;or if it has been corrected, • ••
interlined or altered in any manner. . ' ' Cy9ift
VR21(REV.7/09) FEE PAID$ 40.00 DATE 04 / 28 /2020 040 .,0000 By_Service_Ev_ital
MM DD YYYY 41I.OF
Rafaela Ramirez
Schuyler Hill Funeral Home
TR050120 FH06/C09/051
Public Health Law Sec. 4145(2b) - 013779
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#—