Bynum, Elvin NEW YORK CITY THE CITY OF NEW YORK-'DEPAR`iiiewr OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
April 30,2020 07:20 AM 156-20-038198
EVENT:(CHECK ONLY ONE) ®DEATH ❑SPONTANEOUS TERMINATION [INDUCED TERMINATION CEanFICATENUUBEA
NAME First,Middle,Last AGE SEX OF
MONTH DAY YEA)
OF
Elvin Bynum 68 Male EVENT 04 24 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
"PLACE OF NEW PORK CITY
EVENT 1-----Brooklyn Universitf Hospital of Brook) n
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY:
CERTIFIER METHOD ❑ INTERMENT ,� CREMATION
OFME,Mu Sarah Thomas
Minakshi Shulda DISPOSAL LlOTHER M.E.CASE d K20035339
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
YYI
OF
DISPOSITION Pineview Crematorium Queensbury, New York DISPOSITION 05 09 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 Hood Funeral Services Inc. 2601 Pitkin Ave Brooklyn NY 02064
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
APPLICANT
Kenneth Hood �E,*&&wKayAuttermcaw 11651
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.NOTICE: This permit is not valid without the seal of the Department ��! •••� !I% iQ��I�'/(7 I Q/��
of Health and Mental Hygiene;or if it has been corrected, ye •
interlined or altered in any manner. a Cry Registrar
VR 27(REV.7/09) FEE PAID$ 40.00 DATE 04 / 26 /2020 % •�. • By-Service E_vital
MM DD YYYY •• '
�'OF,
Public Health Law Sec. 4145(2b) 013759
Receipt
Human remains of delivered on , 20
Pine View*'Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#