Brin, Marisa S(7
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 12,2020 04:04 PM 156-20-024562
EVENT:(CHECK ONLY ONE) ®DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION --�CEFaIWATE KNIBER
NAME First,Middle,Last AGE I SEX I DATE I MONTH DAY (YEAR
OF
Marisa Brin 63 Female EVENT 04 12 2020
PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
EVENT NEW YORK CITY
Brooklyn 254 Rochester Ave #2 Brook) n NY 11213-3942
CERTIFIER NAME ❑ INTERMENT CREMATION
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY:
�$
OF MEIMu Jeremy Stuelpnagel
Jeremy Stuelpnagel DISPOSAL ❑ OTHER M.E.CASE s K20016510
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY (YEYAYRY)
OF
DISPOSITION Pineview Crematorium Queensbury, New York DISPOSMON 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 Brooklyn NY 02064
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
Kenneth Hood Elearvlyambrmcat®a 11651
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE r� UESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department 2j,;"` "'s••!F iQ�`�6' y Q� ./'I
of Health and Mental Hygiene;or if it has been corrected, -'• • ` 11
interlined or altered in any manner. Cly RegWar
VR 21(REV.taros) FEE PAID$40.00 DATE 04 / 15 /2020 41 . •:�,' By Service Evital
MM DO YYYY ••
�'OF.
1 . ;R
Public Health Law Sec. 4145(2b) O' 7 C, 4.
Receipt
Human remains of delivered on j', , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#