Sanchez, Merenciano t - 5�z
NEW YORK CITY THE CITY OF NEW YORK-DEPARTM NT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE OF VRAL RECORDS
AND MENTAL HYGIENE
April 28,2020 11:50 PM PERMIT TO DISPOSE OF OR ThANSPORT HUMAN REMAINS
156-20-037561
EVENT:(CHECK ONLY ONE) X DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFicrire N-UM-BE,R
NAME First,Middle,Last AGE I SEX I DATE MONTH DAY YEAR
OF (YYYY)
Merenciano Sanchez 50 Male EVENT 104 28 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Manhattan New York Presbyterian Hospital
CERTIFIER
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT X CREMATION CREMATION APPROVED BY:
OF ME/MLI Adrienne Licking
Joseph Villarin DISPOSAL ❑ OTHER M.E.CASE#M20033410
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF (YYYY)
DISPOSITION Pineview Crematory Queensbury, NY DISPOSITION 105 11 2020
1
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 Bronx NY 00897
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
Thomas Roemmelt C 4?a cV&mmee Sv9 tumEb tromwlNAn a M 13080
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department
of Health and Mental Hygiene:or if it has been corrected, : P i�
interlined or altered in any manner. Z�. •
City Registrar
VR 21(REV.7/09) FEE PAID$40.00 DATE 04 / 30 /2020 •, . �0 By Service_Ev_ital
MM DD YYYY
Public Health Law Sec. 4145(2b) 01 3 7 7
Receipt
Human remains of i delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#