Brown, Udel a
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NEW YORK CITY THE CITY OF NEW YORK.—DEPARTMENT OF HEALTH AND MENTAL HYGIENE
a
DEPARTMENT OF HEALTH - y 6FFICE OF VITAL RECORDS
AND MENTAL HYGIENE PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
March 20,2020 05:03 PM 156-20-012433
EVENT:(CHECK ONLY ONE) N DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION ------------ceiniFlci►ii NUMBER
NAME First,Middle,Last AGE SEX I DATE MONTH DAY YEAR
OF (YYYY)
Udel Brown 81 Female I EVENT 03 20 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Brooklyn Crown Heights Center For Nursing and Rehabilitation
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY:
CERTIFIER METHOD ❑ INTERMENT CREMATION OF ME/MLI Ian Bautista
Jasodaden Mandalaywala DISPOSAL ❑ OTHER M.E.CASE# K20029833
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF (YYYY)
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.V.STATE LIC.#
APPLICANT �Z�Kenneth Hood El IyAu�.— 111651
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, ••' _
interlined or altered in any manner : a T CQy Regl51rar
VR21(REV.7/09) FEE PAID$40.00 DATE 03 / 21 /2020art•Er•� By_Monique Bruton-Santiag
MM DO YYYY
Public Health Law Sec. 4145(2b) Q 1, T3
Receipt
i
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#