Ramsey, James 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
April 15,2020 01:19 AM _1.56-20-026W _
EVENT:(CHECK ONLY ONE) ®DEATH [I SPONTANEOUS TERMINATION El INDUCED TERMINATION _cERTIFICwTE NUMBER
NAME First,Middle,Last AGE SEX DATE MONTH DAY vEAR
OF
James Ramsey 62 Male EVENT 04 13 2020
PLACE OF NEW PORK CITY BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
EVENT Bronx 1520 Sto Ave Apt 904 Bronx NY 104734584
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER M OD LI INTERMENT CREMATION CREMATION APPROVED BY:
CERTIFIER OF ME/MLI Kristen Landi
Kristin Hord DISPOSAL (] OTHER M.E.CASE, B20017050
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 DISPOSITION 1 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.
NAME OF ESTABLISHMENT ADDRESS CITY AND STATE N.Y.STATE REG.#
FUNERAL
ESTABLISHMENT Hood Funeral Services Inc. 2601 Pitkin Ave Broold n NY 02064
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) I SIGNATURE N.Y.STATE LIC.#
Kenneth Hood ElaaryAw >a°
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department
of Health and Mental Hygiene;or if it has been corrected, • • y/���'""' Q/1��,��
interlined or altered in any manner : Cly Registrar
VR 21(REV.7/09) FEE PAID$40.00 DATE 04 / 15 /2020 %y�•� •: By Service Evital
MM DD YYYY �►'octA�.`r`
Public Health Law Sec.4j45(2b) 1
Receipt
Human remains of delivered on , 20
Pine View Cemetery' Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#