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Santiago, Daniela B. Palen NENNYORKCITY THE CT'OF NEWYORK-C6RY1F WOF xGLM AND MFN HYGENE VII OEPAARAENF OF HEALTH OFFICE OF VITAL RECORDS AND MENTAL HYGIENE Mayll.2 OSCIAM PERMFF TO DISPOSE OF ON TRANSPORT HUMAN REMAINS 15620-0/3287 EVENT IcxEC FeONLY Area Li b n MDEAnI F]sPIXRANEOV$TMMNAn11N owoDCEORPAGE NAME tWb, RE onvy Dermal R Palen Land 71 DIL 11 20M PLACE OF NflY Y0YK C11Y m� xwNmwrmumsmmnwme�Tmes N U Lut arin REARTo AT CER MER NAME mvuuumMmc.....M.sex 0INN nr p(ae+rr 1 uMM Ian INS Baul OF Neron MCMew wesAL OmrFe im lM.a l7A ax H2Oomw PLACEOF meeaxwxmenewcampnrcsmu mmrvn RxUmRrtDAMOR Mm �.avE Pine Vlew CremelOry 0ueendbury, AN I umcenwN OS 14 20M THE HAVING BEEN HURT ASREQUIRLD by RE ICENCE BEEN PLED wnH GDVERNING FIRE PREPARATION AND DEPOSON.OF HUMAN REMAINS wM e xM �PERMMS1oN a HEREBY REQUESTED M DISPONS OF THE E�NS AS IDENTIFIED ABOVE 6ertRRwMDrt s uUm�re emrta A FUNERAL 4 MUMMEHT D'Atlevo Funeral HMO. Inc. 1M SMwnen Ave Eirtardyn NY OOA07 APPLICANT HAUTEUR xr.A'nrt LNtNNAo aLrEucoinu'Im © c^' a xv.anreuc.r John 00'AnenzD cfl Cvub` AMEMENNAMEAREAREj 10843 PERMISSION HEREBY GRANTED IDDISPOSE OF THE RE JESTED ABOVE. ��� WnC : This memll Ls RAW valid Vital Do teal of the OMmlmenl ;.. .. ......,,i T W Her eM Mama HYAene,or AS RED Dean wnacbl. ANALTm or Ahmed ,any mUnnec 6F3 m x:INEv iM FEE PAID$w0] GATE RE J2020 j! 9YServ¢e ENel Anyars, ` Nblic Health Law Sec. 4145(2b) _ 013812 Receipt Humaa remains of� A — n Z -� _ Poe Yew Cenc¢ry Repeuumg Ne(uvaa1 og�d� OffitiL FuoeMD ta Re g.m LiceowN�z...l � 0