DFS- RELEASE FORM

RELEASE FORM

Drolette Funeral Services, Inc.

DBA Ashley~Drolette Funeral Home

35 Oak Street, Middleborough, MA 02346

Main: 508 947-3600

Fax: 508 947 - 0792

Name of Facility (Where Your Loved One Currently Is)

Address Of Facility

City/Town, State, Zip

Other

Name of Deceased

To Whom It May Concern: I hereby authorize and request that ____________________________ be released to the care and custody of Drolette Funeral Services, Inc., DBA Ashley~Drolette Funeral Home. Please forward any and all personal belongings to the Funeral Home as well. Thank you for the assistance with this matter.

Sincerely,

NEXT OF KIN Signature

NEXT OF KIN Name

Relationship

Address

City/Town, State, Zip