Garcia, Persio NEW YORK CITY THE CITY OF NEV K-DEPARTMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE
May 04, 2020 09:56 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-20-040708
EVENT:(CHECK ONLY ONE) M DEATH ❑SPONTANEOUS,TERMINATION ❑INDUCED TERMINATION ------
CERriFicarl=NUMBER
NAME First,Middle,Last --j—AGE I SEX DATE MONTH DAY {YYYY)
OF
Persio Garcia 74 Male EVENT 04 25 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Manhattan Mount Sinai St. Luke's
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER
CERTIFIER METHOD U INTERMENT y�CREMATION CREMATION APPROVED BY:
OF MEWLI AngelaL Capellupo
Abhinav G Hoskote DISPOSAL LJ OTHER M.E.CASE N M20040991
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF (YYYY)
DISPOSITION Pine View Crematory Queensbury, NY DISPOSITION 05 05 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 i ADDRESS CITY AND STATE N.Y.STATE REG.#
ESTABLISHMENT New Leaf Cremation 3930 Long Beach Rd Island Park NY 02058
APPLICANT
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURES�- N.Y.STATE LIC.#
ua�zeG �
Michael Noll S,9.t—El--j llyA.IMM sled 14105
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE. 1
+•••' r
NOTICE: This permit is not valid without the seal of the Department
of Health and Mental Hygiene;or if it has been corrected,
interlined or altered in any manner. i iCly RQ Irar
7,i •�,
VR 21(REV.7109) FEE PAID$40.00 DATE 04 / 25 /2020 i 00. � * By Service.Evital
MM DD YYYY
Public Health Law Sec. 4145(2b) 01 6
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on.burial.permit
Official Funeral Directors Reg.or License#