Stafford, James ...>1 D3O
NEW YORK CITY THE CITY OF NEW YORK—DEPARTMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE OCTOBER 12,2018 05:38 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-18-042373
EVENT:(CHECK ONLY ONE) Vg DEATH ❑SPONTANEOUS TERMINATION 0 INDUCED TERMINATION CERTIFICATE NUMBER
NAME First,Middle,Last AGE SEX DATE MONTH DAY YEYAR
OF
James Albedj, Strafford 57 Male EVENT 10 11 2018
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Manhattan Memorial Sloan-Kettering Cancer Center
NAME OF PHYSICIAN OR MEDICAL EXAMINERS NUMBER CREMATION APPROVED BY:
CERTIFIER METHOD ❑ INTERMENT II CREMATION
OF ME/MLI Russell Czvekus
Nancy Cruz Sitner, NP DISPOSAL ❑ OTHER M.E.CASE# M18024137
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF (YYYY)
DISPOSITION Pine View Crematory Queensbury, NY DISPOSITION 10 16 2018
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.
NAME OF ESTABLISHMENT ADDRESS CITY AND STATE N.Y.STATE REG.#
FUNERAL
ESTABLISHMENT Paccione Funeral Services 530 Narrows Road S Staten Island, New York 01309
APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
g&co
Rocco P. Paccione c� Signature Electronically Authenticated 12747
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE R , :EQUESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department v'�:,' `�" �y �,.�'�4�lli!/ / 1-2.�,.
of Health and Mental Hygiene;or if it has been corrected, z•. ` `j�• O
interlined or altered in any manner. P;= ;" City Registrar
VR zi(REV.7ro9) FEE PAID$40.00 DATE 10 / 12 /2018 :i ••.dt,* By Rudolph Wiggins
MM DD YYYY Cc,Cf tidN'''k