Hopkins, Lynne I ��
NEW YORK CITY THE CrrY OF NEW YORK—DEPARTMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE
July 28,2022 03:31 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-22-034773
EVENT:(CHECK ONLY ONE) Al DEATH 0 SPONTANEOUS TERMINATION 0 INDUCED TERMINATION '---cainwcirE Nuliel a
NAME First,Middle,Last AGE SEX DATE MONTH DAY YEARYYYI
OF
Lynne Hopkins 54 Female EVENT 07 25 2022
PLACE OF BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
EVENT NEW YORK CITY
Manhattan New York Weill Cornell Medical Center
NAME OF PHYSICIAN OR MEDICAL EXAMINERS NUMBER CREMATION APPROVED BY:
CERTIFIER METHOD O
OF INTERMENT (CREMATION MElMLI Ella Kaminsky
Courtney Bellissimo DISPOSAL ❑ OTHER ME.CASE I M22023656
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY (YEAR
OF
DISPOSON ITI
Pine View Crematorium Queensbury,New York DISPOSITION 07 29 2022
THE CERTIFICATE OF DEATH HAVING BEEN FILED AS REQUIRED BY THE HEALTH CODE,AND AU.LAWS AND REGULATIONS
GOVERNING THE PREPARATION AND DISPOSAL OF HUMAN REMAINS HAVING BEEN COMPLIED WITH,PERMISSION IS
HEREBYTREQUESTED 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 NY 01475
NAME OF N.Y.STATE LICENSED FUNFRAI DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.N
APPLICANT
Andrew G.Apostle 'Y 9,9...e..ica•M•,.,ke., 10094
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE ;s,. •`,'? •UESTED ABOVE. / ', /
NOTICE: This permit is not valid without the seal of the Department 4.6!•'.".'O•4 /�,��a+y 4�� QI�
U /
of Health and Mental Hygiene;or if it has been corrected,
E e(IS, ��
interlined or altered in any manner. �. : 1 . •`:�a City Registrar
41
VR 21(REV.7/09) FEE PAID$40.00 DATE 07 / 27 /2022Y • ,,•• tc'* By Service Evital
Mm OD Of NLVI
11
Public Health Law Sec. 4145(2b) ,l '' `/'
Receipt
_
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home nary ed on burial permit
Official Funeral Directors Reg.or License#