Tello,Francisco NEW YORK CITY THE CITY OF NEW YORK—DEPARTMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE
April 29,2020 03:35 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-20-037882
EVENT:(CHECK ONLY ONE) M DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION - ceanFicnre NUMeeR
NAME First,Middle,Last AGE I SEX I DATE MONTH DAY YEAR
OF YYYY)
Francisco Tello 80 Male EVENT 04 27 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW PORK CITY
EVENT Bronx North Central Bronx Hospital
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ] INTERMENT >(CREMATION CREMATION APPROVED BY:
CERTIFIER OF ME,MLI Anne Laib
Vimala Ramasamy DISPOSAL :1 OTHER M.E.CASE s B20024725
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 02 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 I ADDRESS CITY AND STATE N.Y.STATE REG.#
FUNERAL
ESTABLISHMENT Sisto Funeral Home, Inc. 3489 E Tremont Ave Bronx NY 01601
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.V.STATE LIC.#
APPLICANT
John J. Sisto sg--El—n-lly—n-tol 13334
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department! •!�= ik ��'/fly Q/�/",/'/
of Health and Mental Hygiene;or if it has been corrected,
interlined or altered in any manner. Cly Registrar
VR 21(REV.7/09) FEE PAID s 40.00 DATE 04 / 28 /2020 0 • By Service_Evital
MM DIDYYYY •�00!'�
Of N0
-7;�CSGOO— F409 ccx� Oj(
Public Health Law Sec. 4145(2b) i 013751
Receipt
Human remains of delivered on , 20
Pine View`Cemetery representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#_