Reid, Michael NEW YORK CITY THE CITY OF NEW YORK—DEPARTMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
May 09,2020 03:06 AM 15&20-042729
EVENT:(CHECK ONLY ONE) ®DEATH ❑SPONTANEOUS TERMINATION D INDUCED TERMINATION ---- CIEFMRCATENUMBER
NAME First,Middle,Last AGE I SEX DATE MONTH DAY YEAR
OF (YYYY)
Michael Reid 65 Male EVENT 104 15 2020
-F
PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
EVENT NEW YORK CITY
Brooklyn Mount Sinai Brooklyn
CERTIFIER
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT CREMATION
CREMATION APPROVED BY:
y'�
OF ME/MLI Nia John
Charmaine Demetrius DISPOSAL ❑ OTHER M.E.CASE# K20042992
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF (YYYY)
DISPOSITION Pineview Crematorium Queensbury, New York DISPOSITION 05 09 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 Hood Funeral Services Inc. 2601 Pitkin Ave Brook) n NY 02064
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
Kenneth Hood I IeElemmicatyA,DMI000W 11651
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department i�!!0!',';�
of Health and Mental Hygiene;or if it has been corrected, -'• `'.i
interlined or altered in any manner.: 1 Cly RegMrar
VR 21(REV.7/09) FEE PAID$ 40.00 DATE 04_i 28 /2020 'S.r•��••• By Service Evital
MM DD YYYY 4tyOF,,
Public Health Law Sec. 4145(2b) 01 7 6
Receipt
Human remains of delivered on t , 20
Pine Vzew Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#