Judge,Michael J. k ss
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Michael J Judge Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/01/2020 66 Years War or Dates
F Place of Death Hospital,Institution or
Z City,Town or Village Hempstead Town Street Address 24 Cortelyou Road,Merrick Hamlet,Hempstead Town,New York 11566
W Mannerof Death Undetermined Pending
W � Natural Cause �Accident �Homicide �Suicide
Circumstances Investigation
W Medical Certifier Name Title
Tamara Bloom MD
Address
2251 Hempstead Tpke,East Meadow,New York 11501
Death Certificate Filed District Number Register Number
City,Town or Village Hempstead 2950
❑Burial Date Cemetery,Crematory or Facility Name
05/08/2020 Pine View Cemetery&Crematorium
nEntombment Address
nCremation Queensbury Hamlet,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
~ Hold Address ,
to
O
(L Date Point of
U) ElTransportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home N F Walker Inc 01234
Address
2039 Merrick Avenue,Merrick Hamlet,New York 11566
Name of Funeral Firm Making Disposition orto Whom
H Remains are Shipped,If Other than Above
M Address
cr
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/05/2020 Registrar of Vital Statistics Kot(z(een Murray(E(ectronicaCCySigned)
(signature)
District Number 2950 Place Hempstead, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 51 Place of Disposition /V
Uj
N (section) (lot number) (grave number)
Name of Sexton or Person in Charge f Premises; r✓io,' '� '
(please print)
ti Title
W Signature l
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0 1 3 7P d 7
Receipt
Human remains of ! delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#