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Kowaiski, Phyllis j .�.. ,'KSTATE DEPARTMENT OFHEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Phyllis Kowalski Female Date of Death Age If Veteran of U.S.Armed Forces, 05/04/2020 86 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Hempstead Town Street Address Mount Sinai South Nassau Manner of Death © Natural Cause Ej Accident Homicide Suicide Undetermined Pending Medical Certifier Name Title Circumstances Investigation Jonathan Altus MD Address 1 Healthy Way, Hempstead Town,New York 11572 Death Certificate Filed District Number Register Number City,Town or Village Hempstead 2950 ❑Burial Date Cemetery,Crematory or Facility Name ❑ 05/07/2020 Pineview Crematory Entombment Address 0 Cremation Queensbury Hamlet,New York ❑Donation ❑Removal Date Place Removed and/or and/or Held Hold Address Transportation 1100LDate Point of by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Macken Mortuary Inc 01089 Address 52 Clinton Avenue,Rockville Centre Village,New York 11570 Name of Funeral Firm Making Disposition or to Whom �• Remains are Shipped,If Other than Above Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/06/2020 Registrar of Vital Statistics xathfeen Murray(ECectronicaCCy Signed (signature) District Number 2950 Place Hempstead, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition Place of Disposition (address) wl IXI (sedion/ t number) (grave number/ Name of Sexton or Person in Charge of PremiseUj s (p/ease riot/ Signature Title DOH-1555(07/18)p 1 of 2 ..7 ` Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#