Mirkovic, MiloradSep 2419, 05:57p McKeon Funeral Home 7186556461 p.1 9416
NEW YORK CITY THE CITY OF NEW YORK — DEPARTMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH AND MENTAL HYGIENE OFFICE OF VITAL RECORDS
Septelnber24, 201901:41 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
EVENT: (CHECK ONLY ONE) X DEATH ❑ SPONTANEOUS TERMINATION ❑ INDUCED TERMINATION
156-19-038875
NAME
First, IaLddK Last
AGE
SEX DAB I MONTH DAY
OF i�
Milorad Mirkovic
55
Male EVENT 09 22 2019
PLACE OF
BOROUGH
NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
EVENT
NEW YORK CITY
Queens
2016 38th St, A t 3, Astoria, NY 11105-2049
CERTIFIER
NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER
METHOD
LI WTERNENT X CREMATION CREMATION APPROVED BY;
OF
Nadu Melanie Gutteea
Eugene Perlov
DISPOSAL
01 OTHER M E CASE. Q19023303
PLACE OF
NAME OF CEMETERY OF CREMATORY (ORDESTINAT/ON)
CITY OR COUNTY AND STATE
DATE
MONTi DAY YEAR
DISPOSITION
pine View Crematory
Queensbury, New York
OF
DISPOSITION
(YvrYt
09 26 2019
i nC QM—AIC V.- UCAl" MAVINU 0=11 rILtU AJ HtUUIHtU t3Y IMF: 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 ESTAB-ISHMENT ADDRESS CITY AND STATE N.Y. STATE REG. 4
ESTABLISHMENT John F.X. MCkeon & Son, Inc. 1 3129 Perry Ave Bronx NY 00890
APPLICANT NAME OF N.Y. STATE LICENSED FUNERAL DinECTOR (PRINT) SIGNATURE N.Y. STATE UC.
Ronald R Schne f Jr.� cfz. s�....� d�,:.U,.wti 13959
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE n QUESTED ABOVE.
NOTICE: This permit is not valid without the seal o1 the Department �°•,.="1 —tr h 7i1
of Health and Mental Hygiene; or if it has been corrected,:
interlined or altered in any manner., City Registrar
VR 21 (REV. 7/09) FEE PAID $ 40.00 GATE 09 / 23 i2019 '.,t'x•� ;�� �•�.• By Kaniz Kazi_
MIt DO) YYYY [}fl,� • •t
Cf NE��
Public Health Law Sec. 4145(2b)
012582
Receipt
j
Human remains of -;' �'' delivered on ' , 20 ;' " f
Pine View Cemetery Representing the funeral home named p> burial permit
Official Funeral Directors Reg. or License # ' ' '