Release Of Body To Funeral Home Form

Release Of Body To Funeral Home Form
Deceased Information
Full Name of Deceased
First NameLast Name
Date of Birth
MonthDayYear
Date
Date of Death
MonthDayYear
Date
Place of Death
Cause of Death (if known)
Funeral Home Information
Name of Funeral Home
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address of Funeral Home
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Authorizing Party:
I, the undersigned, hereby authorize the release of the body of the deceased individual named above to the specified funeral home. I understand that this release is necessary for the funeral home to make arrangements for the funeral and disposition of the deceased.
Relationship to Deceased
Other
Date
MonthDayYear
Date
Signature
Clear
Should be Empty:

Deceased Information