Zapata, Fernando "t'07
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
May 03, 2020 04:11 PM 156-20-040043
EVENT:(CHECK ONLY ONE) IN DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION --CERTIFICATE NUMBER
NAME First,Middle,Last AGE I SEX I DATE MONTH DAY Y EAR`)
OF
Fernando Zapata 65 Male EVENT 05 01 2020
PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
EVENT NEW PORK CITY
Queens Long Island Jewish Forest Hills
CERTIFIER NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT CREMATION CREMATION APPROVED BY:
OF ME/Mu Saundra Hensley
Dhawani N Pandya DISPOSAL ❑ OTHER M.E.CASE IV Q20040635
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
DISPOSITION OF (YVYY)
Pine View Crematory Queensbury, NY DISPOSITION 05 05 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 Fox Funeral Home, Inc. 9807 Ascan Ave Forest Hills NY 00603
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE ��/�/y N.Y.STATE LIC.#
Steven Duea UM Signature Electronically Authenticated 14007
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE QUESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department =o• go*�;*tr
of Health and Mental Hygiene;or if it has been corrected, •
interlined or altered in any manner.: City Registrar
VR 21(REV.7/09) FEE PAID$ 40.00 DATE 05 / 03 /2020 •� . • By_Serv_ice_Evit_al
MM DD YYYY 4ly ,�E.J�y
Public Health Law Sec. 4145(2b) 01.3699
Receipt
Human remains of delivered on . , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#