Gonzalez, Epifania 6� I
NEW YORKSTATE DEPARTMENT0F HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Epifania Gonzalez Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/25/2020 101 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Yonkers Street Address Sjrh-St Johns Division
p Mannerof Death ❑X Natural Cause ❑Accident ❑Homicide Suicide Undetermined ❑Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
Joseph Nshiewat MD
Address
967 N Broadway,Yonkers,New York 10701
Death Certificate Filed District Number Register Number
City,Town or Village Yonkers 5907 632
Burial Date Cemetery,Crematory or Facility Name
05/02/2020 Pine View Crematory
Entombment Address
K Cremation Queensbury Hamlet,New York
❑Donation
zRemoval Date Place Removed
and/or and/or Held
H N Hold Address
0
d Date Point of
U) Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Sisto Funeral Home Inc 01601
Address
3489 E Tremont Ave,Bronx,New York 10465
Name of Funeral Firm Making Disposition or to Whom
�— Remains are Shipped,If Other than Above
Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/30/2020 Registrar of Vital Statistics ,7e sicaCinguina(Ek tronicallySyrred)
(signature/
District Number 5907 Place Yonkers, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H p
WDate of Disposition I�Z( Zv Place of Disposition �r
2 (address)
W
N
Ir (section) /(11number) (grave number)
0 Name of Sexton or Person Ige&ofre
� �e (pleaseprint)ZW Signature
Title
DO H-1555(o7/18)p 1 of 2
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Public Health Law Sec. 4145�2b}'''"" 013755
Receipt
Human remains of G delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#