Hicks, Pamela NEW YORK CITY THE CITY OF NEW YORK—DEP;�iTMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
May 08,202010:31 AM 156-20-042384
EVENT:(CHECK ONLY ONE) 19 DEATH ❑SPONTANEOUS TERMINATION 0 INDUCED TERMINATION CERTIFICATE NUMBER
NAME First,Middle,Last AGE I SEX I DATE I MONTH DAY YEYIARY)
OF
Pamela Hicks 53 Female EVENT 04 08 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Brooklyn Mount Sinai Brooklyn
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER M I CREMATION APPROVED BY:
CERTIFIER EO OD O INTERMENT CREMATION ME/MLI Cheryl Luning
Adam Brenner DISPOSAL ❑ OTHER M.E.CASE I K20039619
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF
DISPOSITION Pineview Crematorium Queensbury, New York I DISPOSmON 105 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.
NAME OF ESTABLISHMENT ADDRESS CITY AND STATE N.Y.STATE REG.#
FUNERAL
ESTABLISHMENT Hood Funeral Services Inc. 2601 Pitkin Ave Brooklyn NY 02064
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
APPLICANT
Kenneth Hood �awwdrcricawyxe,e draw 1 11651
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE L UESTEED ABOVE. 1%
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 any manner. Cly RegMrar v04.
—
VR 21(REV.7/09) FEE PAID$ 40.00 DATE 04 / 22 /2020 By Service Evital
MM DD YYYY • '
D)►'OF,
r
Public Health Law Sec. 4145(2b) 0 IL3 7 6 2
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#