Huertas, Maria 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 02, 2020 0231 PM 156-20-039609
EVENT:(CHECK ONLY ONE) 1K DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION ---""""""""""---RTI-"-ICA".E NUMBER
CERTIFICATE NUMBER
NAME First,Middle,Last AGE I SEX DATE MONTH DAY YEAR
OF (YYYY)
Maria Huertas 85 Female EVENT 04 26 2020
PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
EVENT NEW YORK CITY
Brooklyn Maimonides Medical Center
CERTIFIER
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT 51 CREMATION CREMATION APPROVED BY:
OF ME/MLI Floriana Persechino
Neilakash Beharry DISPOSAL ❑ OTHER M.E.CASE K20039872
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
DISPOSITION OF (YYYY)
Pine View Crematory I 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.
FUNERAL NAME OF ESTABLISHMENT rADIRESS CITY AND STATE N.Y.STATE REG.#
ESTABLISHMENT Fox Funeral Home, Inc. 07 Ascan Ave Forest Hills NY 00603
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE ��p/y N.Y.STATE LIC.#
Steven Duca d ft,-M aNm 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 2j•�, �': r� yyll
of Health and Mental Hygiene;or if it has been corrected, z�• •sA&I
Y Q/J�/V �
interlined or altered in any manner.: City Registrar
VR21(REV.7/09) FEE PAID$ 40.00 DATE 04 / 30 /2020 ' 46 . •0 By_ServiCe_Evital
MM DD YYYY �,OFNe'l
Public Health Law Sec. 4145(2b) 0--13?0 2
Receipt
Human remains of delivered on- ` , 20_
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#,