AUTHORIZATION TO COPY PHOTO & POST OBITUARY ON HARRIS FUNERAL HOME WEBSITE

AUTHORIZATION TO COPY PHOTO & POST
OBITUARY ON HARRIS FUNERAL HOME WEBSITE

1. PARTIES AND DEFINITIONS:

"FUNERAL HOME": Harris Funeral Home

"REPRESENTATIVE"

"DECEDENT"

2. RELATIONSHIP OF REPRESENTATIVE: The REPRESENTATIVE warrants and represents to the FUNERAL HOME that the relationship between the REPRESENTATIVE and the DECEDENT is as follows:

(Check the appropriate box)

SpouseNext-of-Kin (Closest Living Relative)Personal Representative of the Next-of-Kin with written authorization of Next-ofKin to act on his or her behalf.Other

3. AUTHORITY OF REPRESENTATIVE: The REPRESENTATIVE warrants and
represents to HARRIS FUNERAL HOME that the REPRESENTATIVE is the person or the
appointed agent of the person who by law has the paramount right to arrange and direct the disposition of the remains of the DECEDENT and that no other person(s) has a superior right over the right of the REPRESENTATIVE.

4. AUTHORIZATION: The REPRESENTATIVE authorizes the HARRIS FUNERAL
HOME to use Photograph(s) for the TRIBUTE of the DECEDENT and posting the
DECEDENT’s obituary on the FUNERAL HOME’s website and/or other websites on the
internet that list obituary and death notices. The REPRESENTATIVE hereby releases
HARRIS FUNERAL HOME from all liability that may arise from the posting of the obituary.

Date

Signature of Representative

Clear