Marshall, Evangeleanah Amelia NEW YORK CITY THE CITY OF NEW YORK—DEPARTMENT OF HEALTH AND MENTAL HYGIE ELF Si/ iq
DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS
AND MENTAL HYGIENE
January 23,2024 06:59 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS
156-24-003626
EVENT:(CHECK ONLY ONE) DEATH ❑SPONTANEOUS TERMINATION ❑INDUCED TERMINATION CERTIFICATE NUMBER
YEAR
AGE SEX DATE MONTH DAY
NAME First,Middle.Last (YYYY)
OF
Evangeleanah Amelia Marshall 11 Female EVENT 01 22 2024
BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS
PLACE OF NEW YORK CITY
EVENT Manhattan New York Presbyterian Hospital
NAME OF PHYSICIAN OR MEDICAL EXAMINERS NUMBER CREMATION APPROVED BY:
CERTIFIER METHOD ❑ INTERMENT X CREMATION
OF ME/MLI Michael Vaivao
Thomas Kuriakose DISPOSAL ❑ OTHER M.E.CASE#M24002869
PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR(YYYY
F
DISPOSITION Pine View Crematory Queensbury, New York DISPOSITION 01 26 2024
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 International Funeral Service of New York,Inc. 4123 4th Ave Brooklyn NY 00830
NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.#
APPLICANT
Stephanie Garcia Morales cfc � iieaa � Signature Electronically Authenticated 14764
PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE A Vt. Al? QUESTED ABOVE.
NOTICE: This permit is not valid without the seal of the Department =�, t� dui,Vfe.....„"
of Health and Mental Hygiene;or if it has been corrected, 4'• t `'.•• /40.44.4„,
interlined or altered in any manner. Q; . ''�';,,•0
.' ,�,; a' City Registrar
40.00 DATE 01 / 23 /2024 'y�. wi1'''':* ByService Evital
VR21(REV.7/09) FEE PAID$ � � �
MM DD YYYY • VO
�Of NE�y
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#