Adams, Sharon 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
APriI 12,2020 02:34 PM 156-20-024460
EVENT:(CHECK ONLY ONE) N DEATH ❑SPONTANEOUS TERMINATION El INDUCED TERMINATION CERTIFICATE NUMBER
NAME First,Middle,Last AGE I SEX DATE MONTH DAY YEAR
OF
Sharon Adams 76 Female EVENT 04 11 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW PORK CITY
EVENT Queens 2802 8th St Apt 1A Astoria NY 11102-4208
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY:
CERTIFIER METHOD ❑ INTERMENT y� CREMATION
OF ME/MLI Anne Laib
Kristin Hord DISPOSAL ❑ OTHER M.E.CASE# Q20016089
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF
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
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
Kenneth Hood +�
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE VESTED ABOVE.
•a•
NOTICE: This permit is not valid without the seal of the Department r`.� ,..• "*�: �W-1
of Health and Mental Hygiene;or if it has been corrected, �• s
interlined or altered in any manner. Cly RegWor
VR 21(REV.7/09) FEE PAID$ 40.00 DATE 04 / 16 /2020 •�. .• ' By_Service_Evital
MM DO YYYY •••
�V pF NE`►`
Public Health Law Sec. 4145(2b) 013739
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#