Donato, Steven — NEW YORK CITY THE CITY OF NEW`rK—DEPARTMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE
April 15,2020 11:24 AM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-20-027151
EVENT:(CHECK ONLY ONE) X DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION ---------CERTIFICATE NUMBER
NAME First,Middle,Last AGE I SEX DATE MONTH DAY YEAR
OF (YYYY)
Steven Donato 57 Male EVENT 04 11 2020
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Queens St.John's Episcopal Hospital
CERTIFIER
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD L I INTERMENT X CREMATION CREMATION APPROVED BY:
OF 1 ME/MLI Ella Kaminsky
Donald Morrish DISPOSAL LJ OTHER M.E.CASE#Q2001 8741
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF (YYYY)
DISPOSITION Pine View Crematory Queensbury, NY DISPOSITION 105 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 ADDRESS CITY AND STATE N.Y.STATE REG.#
ESTABLISHMENT New Leaf Cremation 1 3930 Long Beach Rd Island Park NY 02058
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
Michael Noll cwli�o se aNreew nodwiymm�oonwied 14105
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE. 1
NOTICE: This permit is not valid without the seal of the Department �• �` o,!•?� �Y Q�
of Health and Mental Hygiene;or if it has been corrected, • ••sue
interlined or altered in any manner. Cry Registrar
VR 21 (REV.7/09) FEE PAID$40.00 DATE 05 ! 01 /2020 ' •� . • By Service------
MM DO YYYY 4ryOF NO
Public Health Law Sec.414 Qb) 013 715
Receipt
Human remains of delivered on , 20 ,
Pine View Cemetery Representing the funeral home named on burial,permit
Official Funeral Directors Reg.or License# i