AUTHORIZATION

AUTHORIZATION
I hereby designate the above-named funeral establishment to take charge of funeral arrangements for:
and I authorize the release and removal of the remains to said funeral establishment for the purpose of embalming.

I represent that I am the next of kin, or am acting as an authorized agent for the next of kin.
Signed

Clear
Relationship:
Co-Signed:

Clear
Relationship:
WITNESS:
DATE:
FOR VERBAL (TELEPHONE) AUTHORIZATION:
Authorization from
Relationship
Date
Time
Received by
Should be Empty:

FOR VERBAL (TELEPHONE) AUTHORIZATION: