Webb, Ronald 7h
NEW YORK CITY THE CITY 6F NE1 V-FORK-DEPARTMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE
SEPTEMBER 28,2016 02:30 AM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-16-039487
EVENT:(CHECK ONLY ONE) Igl DEATH 0 SPONTANEOUS TERMINATION 0 INDUCED TERMINATION CERTIFICATE NUMBER
NAME First,Middle,Last AGE SEX DATE MONTH DAY YEAREA
OF (YYYY)
Ronald Webb 83 Male EVENT 09 22 2016
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Manhattan New York Weill Cornell Medical Center
NAME OF PHYSICIAN OR MEDICAL EXAMINERS NUMBER CREMATION APPROVED BY:
CERTIFIER METHOD ❑ INTERMENT lid CREMATION
OF ME/MLI
Zachary Sherman DISPOSAL ❑ OTHER M.E.CASE# M16020823
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR
OF (YYYY)
DISPOSITION Pine View Crematorium Queensbury, NY DISPOSITION 09 30 2016
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 Riverdale Funeral Home 5044 Broadway New York, New York 01475
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
APPLICANT Wee di" /e)
Nicholas G.Apostle ! ignature Electronically Authenticated 10097
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE R k` it, :EQUES 'BOVE. 1
of •��ti' ,
NOTICE: This permit is not valid without the seal of the Department ��;<•�'"""'-�,•�� ��� I .•i /4
of Health and Mental Hygiene;or if it has been corrected, '•e'� .'A••1
interlined or altered in any manner. <•. ;. .1c City Registrar
VR 21 (REV.7/09)
FEE PAID$ 40.00 DATE 09 / 28 /2016 *••.•' ''•* By___Jerome-
Zarks
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MM DD YYYY �'OFNE`N�
C) 3 HP ae8vsdt.,y it)Lf/29O'./