Muirhead, Leslene J�
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 08,2020 07:09 AM 156-20-020497
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EVENT:(CHECK ONLY ONE) ®DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFlCATE NUMBER
NAME First,Middle,Last AGE SEX DATE MONTH DAv (YYAR)
I OF
Leslene Muirhead 65 Female EVENT 04 04 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Brooklyn Kin sbrook Jewish Medical Center
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER ICREMATION APPROVED BY:
CERTIFIER METOFOD ❑ INTERMENT CREMATION ME/MLI Carla DeVito
Paul NacierDISPOSAL ❑ OTHER M.E.CASE# K20013907
NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DAB MONTH DAY YEAR
PLACE OF OF (YYvv)
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 EkdrawcallyAuC�enticated 11651
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, �c —
interlined or altered in any manner. i Cly Registrar
VR 21(REV.7/09) FEE PAID$ 40.00 DATE 04 / DD /2020 !00 By-Service_Evital
Public Health Law Sec. 414%2b) 01'13 7.
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#