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Rehak, Stephen { 6 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Stephen Rehak Male Date of Death Age If Veteran of U.S.Armed Forces, 05/01/2020 67 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Hempstead Town Street Address 426 Autumn Drive,East Meadow,Hempstead Town,New York 11554 � Manner of Death © Natural Cause Accident ❑Homicide ❑Suicide Undetermined Pending U Circumstances Investigation LtJ Medical Certifier Name Title G� Tamara Bloom MD Address 2251 Hempstead Tpke,East Meadow,New York 11501 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 ]Cremation Queensbury Hamlet,New York Donation ❑Removal Date Place Removed and/or and/or Held Hold Address +tiff ❑Transportation Date Point of 0 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 Q W CIL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/05/2020 Registrar of Vital Statistics ?Cathleen 94urray(Electronically 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: Date of Disposition 5_� Place of Disposition ; L�� address/ M (section) 1 / (lot number) (grave number) Name of Sexton or Person i ha of P emise �.J w i V4nlh;' >L. (please print) tU Signature Title CrQ m � DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4`145(2b) 013746 � Receipt Human remains of delivered on , 20— Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#