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Simeon, Yves NEW YORK CITY THE CITY OF NEW YORK—DEPARTMENT OF MALTH AND MENTAL HYGIENE DEPARTMENT OF HEALTH OFFICE OF,VITAL RRDS AND MENTAL HYGIENE April 29,2020 09:10 PM PERMIT TO DISPOSE 0P OR TRANSPORT HUMAN REMAINS 156-20-038108 EVENT:(CHECK ONLY ONE) X DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFICATE NUMBER NAME First,Middle,Last AGE I SEX I DATE I MONTH DAY YEAR OF (YYYY) Yves Simeon 65 Male EVENT 04 22 2020 PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS EVENT NEW PORK CITY Brooklyn Kin sbrook Jewish Medical Center CERTIFIER NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD O INTERMENT X CREMATION CREMATION APPROVED BY: OF ME/Mu Sarah Thomas Paul Nacier DISPOSAL Ll OTHER M.E.CASE K20035399 PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR OF (YYYY) DISPOSITION Pineview Crematory Queensbury, New York DISPOSITION 05 01 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 D'Adenzo Funeral Home, Inc. i 104 Skillman Ave Brooklyn NY 00407 APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) I SIGNATURE N.Y.STATE LIC.# ��©�� John O D Arienzo E 10843 PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE. NOTICE: This permit is not valid without the seal of the Department =� •••��i of Health and Mental Hygiene;or if it has been corrected, interlined or altered in any manner. ' City Registrar v — VR 21(REV.7/09) FEE PAID$40.00 DATE 04 27 )2020 00 , �0 By Seryice_Evital MM DD YYYY 4!]OF NDpt� J Public Health Law Sec. 4145(2b) 01- *710 Receipt i Human remains of delivered on ° , 20 r r Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# 9