Walker, John ¢o 3
NEW YORK CITY THE CITY'OF 41EW YORK-DEPACMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
May 05,202011:26 PM 156-20-041269
EVENT:(CHECK ONLY ONE) N DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFICATE NUMBER
NAME First,Middle,Last AGE SEX DATE MONTH DAY I OF YEAR
Y )
John Walker 77 1 Male EVENT 04 14 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Brooklyn Mount Sinai Brooklyn
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER OD r CREMATION APPROVED BY:
CERTIFIER M ❑ INTERMENT CREMATION )OF ME/MLI Cheryl Luning
Charmaine Demetrius DISPOSAL ❑ OTHER S(M.E.CASE# K20039679
NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CRY OR COUNTY AND STATE DATE MONTH DAY YEAR
PLACE OF OF (mrY)
DISPOSITION Pineview Crematorium Queensbury, New York 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.
NAME OF ESTABLISHMENT ADDRESS CITY AND STATE N.Y.STATE REG.#
FUNERAL
ESTABLISHMENT Hood Funeral Services Inc. 2601 Pitkin Ave Brooklyn NY 02064
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
APPLICANT
Kenneth Hood EledaiiwYyAultwnticated 11651
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department =;! !.!F
of Health and Mental Hygiene;or if it has been corrected, �• .0
interlined or altered in any manner. i 1 Cly RQgMrar
VR 21(REV.7/09) FEE PAID$ 40.00 DATE 04 / 6 /202Y0 eM�d By Sery ice Eyital
MDO •FN
Public Health Law Sec. 4145(2b) 01_3 7?
Receipt
1
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#