Diggs, Arlene rsp
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 22,2020 10:34 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
1��t 156-20-033702--------
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EVENT:(CHECK ONLY ONE) DEATH El SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFICATE NUMBER
NAME First,Middle,Last AGE I SEX DATE I MONTH DAY (YEAR
YYYY)
OF
Arlene Diggs 79 Female EVENT 04 22 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 ] INTERMENT X CREMATION CREMATION APPROVED BY:
OF {ME/MLI Cheryl LunlnQ
❑
Amanda Shanner DISPOSAL OTHER 1\M.E.CASE#B20037833
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.#
John J. Sisto / C� S,gnzwreElech,—IlyA.—t— 13334
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
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NOTICE: This permit is not valid without the seal of the Department ,°•� •
of Health and Mental Hygiene;or if it has been corrected, : ��l,, Qaye''
interlined or altered in any manner.. �? eg City Registrar
VR 21(REV.7/09) FEE PAID$40.00 DATE 04 / 28 i2020 ' ,•� •0 By Service_E_v_ital
MM DD YYYY C�.OF No'l
Public Health Law Sec. 4145(2b) Q 13 7 1-71-2.
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#