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Pisierra, Jose 53LI NEW YORK CITY THE CITY OF NEW YORK-DEPARTMENT OF HEALTH AND MENTAL HYGIENE DEPARTMENT OF HEALTH OM-CE OF VITAL RECORDS AND MENTAL HYGIENE April 29,2020 09:10 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS 156-20-038111 EVENT:(CHECK ONLY ONE) X DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION ------------cEariFicnTe NiiMBeR NAME First,Middle,Last AGE I SEX I DATE I MONTH DAY YEAR OF (YYYY) Jose Pisierra 91 Male EVENT 04 27 2020 PLACE OF NEW YORK CITY BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS EVENT Queens New York State Veterans Home at St.Albans CERTIFIER NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER METHOD ❑ INTERMENT CREMATION CREMATION APPROVED BY: � OF ME/MLI Kristin Roman Thomas Bizzaro DISPOSAL ❑ OTHER M.E.CASE#Q20035406 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 DISPOSmoN 105 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'Arienzo Funeral Home, Inc. 1 104 Skillman Ave Brooklyn NY 00407 APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.# John O D'Arienzo / ©�"C6VT 10843 PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE UESTED ABOVE. OE •���•'�ey NOTICE: This permit is not valid without the seal of the Departments �!•!� of Health and Mental Hygiene;or if it has been corrected, • •s Y ,/'V interlined or altered in any manner. ' Cly Registrar v VR 21(REV.7/09) FEE PAID$40.00 DATE 0 27 DD 4 / /2020 ' 00 no**0 By Service_Evital YYYY OF NEB r� f 1 Y jR 1 tf/ jft i I i I Public Health Law Sec. 4145(2b) 0 13726 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#