EFTA00130108

FUNERAL DIRECTOR'S STATEMENT OF AUTHORITY

This statement is made for the purpose of inducing the hospital to release the death certificate and/or the remains of the deceased below-named and with the knowledge that the hospital will rely on the truth of the statements made herein.



THE CITY OF NEW YORK

DEPARTMENT OF HOSPITALS

No death certificate and/or body will be released by he hospital to a funeral director until a copy of this form, properly executed, is on file.

## $$M19019432$$

The remains of: (Name of deceased)

Jeffrey Edward Epstein

By: (Name of person granting authority)

Mark Epstein

who died at:

M.Y. Preby. Noir Lower Marsh

on:[date]

Aug 19,2019

and who is also:

(relationship)

Brother

[Name of hospital or mortuary]

OCMYE Frank E Campbell 1076 Madison Ave NW

THIS AUTHORIZATION HAS NOT BEEN THE RESULT OF Any SOLICITATION BY or IN BEHALF of THE UNDERSIGNED



Signature: (Funeral Director)





New York State Funeral Director's Lic. No.

13247

# Name of Firm

- Abbey Funeral Directors, The

- Andrott Funeral Home

- Becker Undertaking Company

- Blau, Abraham Funeral Directors

- Boulevard - Riverside Chapels

- Boulevard- Riverside Chapels

- Boyd, Claude R. - Caratozzolo Funeral Home

- Boyd, Claude R. - Spencer Funeral Home

- Burr - Davis - Sharpe

- Campbell, Frank E.- The Funeral Chapel

- Casey Funeral Home

- Casey - McCallum - Rice

- Cooke, Walter B.- Kennedy Funeral Home

- D'Andrea Brothers Funeral Home

- Davis George T. Funeral Home

- Dwyer Funeral Home

- Fogarty Funeral Home

- Garlick Funeral Home

- Gramercy Park Chapel

- Hellman Memorial Chapels

- Morris I.J. Inc.

- Morris I.J. Inc.

- Morris I.J. Inc.

- Nagel, Charles P. Funeral Home

- Revsky Memorial Chapel

- Park West - Riverside Chapels

- Quinn - Fogarty

- Quinn, Thomas M. & Sons Funeral Home

- Riverside Memorial Chapel

- Riverside Memorial Chapel

- Riverside Memorial Chapel

- Riverside - Nassau North Chapels

- Schwartz Brothers - Jeffor Memorial Chapel

- Universal Funeral Chapel

- Virginia Funeral Chapel

- Waterbury & Kelly Funeral Home

- Waterbury & Kelly Funeral Home

- Werst, George Funeral Directors

- Whalen & Ball Funeral Home, Inc.

- Other

## Address

<table><thead><tr><th>Address</th><th>City, State, Zip Code</th></tr></thead><tbody><tr><td>1076 Madison Avenue - New York, N.Y.</td><td>10028</td></tr><tr><td>353 Second Avenue - New York, N.Y.</td><td>10010</td></tr><tr><td>352 East 87th Street - New York, N.Y.</td><td>10028</td></tr><tr><td>152 Second Avenue - New York, N.Y.</td><td>10003</td></tr><tr><td>1895 Flatbush Avenue - Brooklyn, N.Y.</td><td>11210</td></tr><tr><td>1450 Broadway - Howlett, N.Y.</td><td>11557</td></tr><tr><td>1785 Door Park Avenue - Deer Park, N.Y.</td><td>11729</td></tr><tr><td>448 Main Street - Babylon, N.Y.</td><td>11702</td></tr><tr><td>504 Gramatan Avenue - Mt. Vernon, N.Y.</td><td>10552</td></tr><tr><td>1076 Madison Avenue - New York, N.Y.</td><td>10028</td></tr><tr><td>350 Slosson Avenue - Staten Island, N.Y.</td><td>10314</td></tr><tr><td>30 Nelson Avenue - Staten Island, N.Y.</td><td>10308</td></tr><tr><td>353 Second Avenue - New York, N.Y.</td><td>10010</td></tr><tr><td>99 Oak Street - Coplague, N.Y.</td><td>11726</td></tr><tr><td>14 Le Count Place - New Rochelle, N.Y.</td><td>10801</td></tr><tr><td>90 North Broadway - Tarrytown, N.Y.</td><td>10591</td></tr><tr><td>136-25 41st Avenue - Flushing, N.Y.</td><td>11355</td></tr><tr><td>1091 Yonkers Avenue - Yonkers, N.Y.</td><td>10704</td></tr><tr><td>152 Second Avenue - New York, N.Y.</td><td>10003</td></tr><tr><td>15 State Street - Spring Valley, N.Y.</td><td>10977</td></tr><tr><td>1895 Flatbush Avenue - Brooklyn, N.Y.</td><td>11210</td></tr><tr><td>21 East Door Park Avenue - Dix Hills, N.Y.</td><td>11746</td></tr><tr><td>46 Greenwich Street - Hempstead, N.Y.</td><td>11550</td></tr><tr><td>352 East 87th Street - New York, N.Y.</td><td>10028</td></tr><tr><td>1700 Coney Island Avenue - Brooklyn, N.Y.</td><td>11230</td></tr><tr><td>333 Amsterdam Avenue - New York, N.Y.</td><td>10023</td></tr><tr><td>162-14 Sanford Avenue - Flushing, N.Y.</td><td>11358</td></tr><tr><td>35-20 Broadway - LIC New York 11106</td><td></td></tr><tr><td>180 West 76th Street - New York, N.Y.</td><td>10023</td></tr><tr><td>21 West Broad Street - Mt. Vernon, N.Y.</td><td>11552</td></tr><tr><td>114-03 Queens Boulevard - Forest Hills, N.Y.</td><td>11375</td></tr><tr><td>55 North Station Plaza - Great Nock, N.Y.</td><td>11021</td></tr><tr><td>114-03 Queens Boulevard - Forest Hills, N.Y.</td><td>11375</td></tr><tr><td>1076 Madison Avenue - New York, N.Y.</td><td>10028</td></tr><tr><td>1707 Hyllan Boulevard - Staten Island, N.Y.</td><td>10305</td></tr><tr><td>45 South Highland Avenue - Ossining, N.Y.</td><td>10562</td></tr><tr><td>1300 Pleasantville Road - Brarcliff Manor, N.Y.</td><td>10510</td></tr><tr><td>71-41 Cooper Avenue - Glendale, N.Y.</td><td>11385</td></tr><tr><td>168 Park Avenue - Yonkers, N.Y.</td><td>10703</td></tr></tbody></table>