Baena, Aura NEW YORK CITY THE CITY OF NEW YORT(y DEPARTMENT OF HEALTH AND MENTAL HYGIENE 51-19
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE
May 06,2020 06:56 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-20-041731
EVENT:(CHECK ONLY ONE) M DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION
CERTIFICATE NUMBER
NAME First.Middle,Last AGE SEX DATE MONTH DAY YEAR
OF (YYYY)
Aura Baena 90 Female EVENT 04 29 2020
PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
EVENT NEW YORK CITY
Queens New Franklin Rehab. & Health Care Facility
CERTIFIER
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT X CREMATION CREMATION APPROVED BY:
OF ME/MLI Ella Kaminsky
Allan Santiago DISPOSAL ❑ OTHER M.E.CASE 4 Q20040961
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR.
DISPOSITION OF (YYYY)
Pine View Crematory 1 Queensbury, NY DISPOSITION 05 07 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 New Leaf Cremation 3930 Long Beach Rd Island Park NY 02058
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
Michael Noll ctc/aeGo�
SignaNre EkNoniwly Aulhenfiwled 14105
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department � .,�" o• r
of Health and Mental Hygiene;or if it has been corrected, Ai�'
interlined or altered in any manner. Cry Registrar
VR 21 (REV.7/09) FEE PAID$40.00 DATE 05 / 04 /2020 BY tal
MM DD YYYY
'4!y:.•'yd ' Service E. -----
Df N
Public Health Law Sec. 4145(2b) _, -' 3 7.4_L
Receipt
Human remains of delivered on r F, , 20
Pine View Cemetery Representing the funeral home named op burial permit
Official Funeral Directors Reg.or License#