Nelson, Paticia D. May 05 2020 11:05AM N. F Walker Funeral Home 516-378-0328 page 1
NEWYORK STATE DEPARTMENT OFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle last Sex
Patricia D.Nelson Femato
Date of Death Age If Veteran of U.S.Armed Forces,
04/18QD20 64 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Hempstead Town _ Street Address 750 J��am Avenue,Uniondale,!Apt a Harr,pNead Town,New York 11551
p Manner of Death ®Natural Cause Accident Homicide Suicide Undetermined Pending
V __-_--___. Circum itances Investigation
Uj Medical Certifier Name Title
Anne Walsh NP
- Address
1983 Marcus Avenue C102,New Hyde Park Hamlet, New York 11042
Death Certificate Filed District Number Register Number
City,Town or Vi Rage Hempstead 2950
❑Burial Date Cemetery,Crematory or Facility Name
Entombment
05/0512020 Pine View Cemetery and Crematorium
-- --
Address
Cremation Queensbury Hamlet,New York
Donation
2 Date Place Removed
0 Removal
and(or and/or Held_____
U)
Hold Address
O
W Transportation Date Point of
5 by Common Shipment
Carrier Devination _ - --
Disinterment Date Cemetery Address
Date CemeteryAddress
❑Reinterment
Permit Issued to Registration Number
Name of Funeral Home N F Walker Inc 01234
Address
2039 Merrick Avenue,Merrick Hamlet,New York 11566
Name of Funeral Firm Making Disposition orto Whom
F Remains are Shipped,If Other than Above
QAddress
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date issued 05102/2020 Registrarof Vital Statistics Kathleen Nurray(rEfactrvnicalTy, S ned)
----
District Number 2950 Place Hempstead. New York
I certify that the remains of the decedent identified above were disposed of in accordance w'th this permit on:
WDate of Disposition l Place of Disposition u F,(L
_' (addrers/
Uj
(sctitionl A (Mrnumber)'I (grarr number)
CName of Sexton or Person in Charge of P mises << �
Z
/pk a print,
Signature __ Title
DOH-1555(07118)P 1 of 2
i
17(1
Public Health Law Sec. 4145(2b)__ 1
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# r_. 4: