Rodriguez, Migdalia 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 27,2020 11:10 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-20-036932
EVENT:(CHECK ONLY ONE) M DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION --------- -cEanFicnre NuiBER-
NAME First,Middle,Last AGE I SEX DATE I MONTH DAY YEAR
OF (YYYY)
Migdalia Rodriguez 71 Female EVENT 04 27 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW PORK CITY
EVENT Bronx Jack D. Weiler Hospital
CERTIFIER
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD :1 INTERMENT X CREMATION CREMATION APPROVED BY:
OF ME/MLI Kristen Landi
Michael Li DISPOSAL ❑ OTHER M.E CASE,B20036531
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.
FUNERAL NAME OF ESTABLISHMENT ADDRESS CITY AND STATE N.Y.STATE REG.#
ESTABLISHMENT Sisto Funeral Home, Inc. 3489 E Tremont Ave Bronx NY 01601
APPLICANT
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT SIGNATURE N.Y.STATE LIC.#
^� r�
John J. Sisto / �Cl SignawreEleVoniallyAuBematetl 13334
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE _ UESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department � •'�' �'.•y. A,,,ylup�
of Health and Mental Hygiene;or if it has been corrected,
interlined or altered in any manner. <0 i� Cry Registrar
• •
VR 21 (REV.7/09) FEE PAID$40.00 DATE 04 30 /2020 :•0 •.•' By Service_E_v_ital
MM DID YYYY C//�.OF NE;,'I•
Public Health Law Sec. 4145(2b) 0 3 75 8
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#