Negron, Victor NEW YORK CITY THE CITY OF NEW YORK;ebEPARTMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE O`VITAL RECORDS
AND MENTAL HYGIENE PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
April 30,2020 10:40 AM 156-20-038270
EVENT:(CHECK ONLY ONE) IK DEATH El SPONTANEOUS TERMINATION El INDUCED TERMINATION -ce'RriFicare rluMeeia
NAME
First,Middle,Last AGE I SEX I DATE MONTH DAY YEAR
OF (YYYY)
Victor Negron 62 Male EVENT 04 26 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW PORK CITY
EVENT Bronx Bronx Park Rehabilitation&Nursing Center
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT CREMATION CREMATION APPROVED BY:
CERTIFIER OF ME/MLI Kenichiro Nakahata
Jonathan T.Chang I DISPOSAL ❑ OTHER M.E.CASE# B20O35344
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 3536 E Tremont Ave Bronx NY 01559
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) S NATURE (�/�o N.Y.STATE LIC.#
Jeannine Carbone e� v a J re Electronically Authenticated 10534
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE QUESTED ABOVE.
is •••�•
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 an manner. �• •"
y ;V Cly Registrar
VR 21(REV.7/09) FEE PAID$ 40.00 DATE 04 / 28 /2020 % •� , •0 By_Service Ev_ital
MM DD YYYY 4ryyy
Victor Negron
Schuyler Hill Funeral Home
TR050120 FH06/C09/045
Public Health Law Sec. 4145(2b) 113
Receipt
Human remains of delivered on i , 20
Pine View Cemetery Representing the funeral home Lnamedn burial permit
Official Funeral Directors Reg.or Lice
1