• Office of Broward County Authorization For Release and Removal Medical Examiner and Trauma Services 5301 S.W. 31 Avenue Fort Lauderdale, Flenda 33312-6619. 954-357-5200 Records FAX 954-327-6581 TTY 954-357-6100

  • Authorization for Release and Removal

  • Decedent

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  • Legally Authorized Person

  • Funeral Facility

  • Witness of Signature

  • BY SIGNING BELOW, I CERTIFY THAT I AM THE "LEGALLY AUTHORIZED PERSON AS DEFINED BY FLA. STAT. $497.005-39 AND DO HEREBY AUTHORIZE THE BROWARD COUNTY MEDICAL EXAMINER TO RELEASE THE REMAINS OF THE ABOVE NAMED DECEDENT TO THE ABOVE NAMED FUNERAL FACILITY

  • Clear
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  • Clear
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  • ALL FIELDS ARE REQUIRED TO BE FILLED OUT TO COMPLETION INCOMPLETE OR ILLEGIBLE RELEASE AUTHORIZATIONS WILL NOT BE ACCEPTED BY THE MEDICAL EXAMINER'S OFFICE "VERBAL" AUTHORIZATIONS WILL NOT BE ACCEPTED.

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