Samaniego, William NEw YORNCIV THE CHY GF XEW YGRE-DGLS.P CM OF HEALTH AND MENTAL HYGIENE r UZD 1
DEPARTMENT OF HEALTH OFFICE OF VRALAECOROS
AND MENTAL HYGIENE PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
May 12. NO 11:36 PM 186-20443787
EYEHT:(CHECK ONLY GAM NOEATX OSPOWANEOUSTERMINATON ❑INDUCED TERMI"MN --
NSA
NAME F,E%kM,ul OF
William Somanla o SA Mele 05 DT 2020
EOF
EYENr NlW YOMLRY< aroRRx NW.avxarnuwNslmndwnemvwRvs
&GON WDOEINNI Ma]i®I DM Mental III Canter
CEREFER xuRrtrllwoww,aocxdwixwsxumeEMITI u ,nol n(,;nrinv 1 c A LBO
RE
M,dulmagH M BMX snuu Dmxw .IOR lmE c.w,K29W3B19
PLACE OF acFmlerwveRcuwienrme cfs,xwr wmuxrvuos,nrt Y MYYA
wMPOa N xn Pone Yew CremalOry aru OuaenaWry, New Yoh D ON CS iA ON
THE CEREIREATE OF IMPORT HAVING BEEN FRED AN AGOVERNING THE PREPARATION AND DISPOSAL OF RUMµ aE MEN COMPLA D WITH PERMIPSIOH IS
HERIERY REQUESTED TO INSPONE OF END REMAINS AS CANDFIED ABOVE
ERENTA IMD„ Esa Me N,Art mre Pms
FUNER
ESTAM16xMENT D'Aaianm FDRemI HOED@, Inc. 10a Skillman Ave Bm01J NT 9910T
APPLICANT Rr^xv.aiLrt,ceuaEorwaPxmREcwlPnxR � ® G��� I .srare,cl
Jo11 OD'Mul¢o /q Gc% �.�A 1O&3
PERMISSION IS HERESY GRANTED TO O6PoBE OF THE PE UMTEG A"',
NDDCE: Tnia cermeiP nDl�andmNOMma PaNalnN DaPNnRMm :�••�.'?i
M TRADE and Mental HYgiene,Or all nu Dave MnslM. . 9_
InleAnad n,MARINE In any Manna,. qy Reg"
m aI IREv.EM FEE PAID S w.O] Mm 05 m IN :){ S OY samia EvXM
adde
Public Health Law Sec 4145i2b) 313813
Receipt
Human remains of - delivered on
Rrevewcemevry Representing Ne funeral home nvnea onhm,al cemtil
Official Funml Prect rs Reg.or License If