Authorization to Accept or Decline Embalming

AUTHORIZATION TO ACCEPT OR DECLINE EMBALMING
RE*
Decedent's Name
Embalming is the addition to, or the replacement of, body fluids by chemical preservatives or the application of chemical preservatives for the temporary preservation of the body. I understand that embalming is not required by law.
Name of Responsible Party*
Accept or Decline Embalming

DoDo not
I understand that for storage or embalming purposes the decedent may be transported to the following location:

Welch-Ryce-Haider Funeral Chapels, 15 East Sola Street, Santa Barbara, CA 93101
The undersigned hereby represents that he/she has the legal right to control disposition of the remains of the decedent.
Signature*

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Relationship to Decedent*
Executed this*
Day
day of*
Month
,*
Year
, at*
Location (city and state)
This section is to be completed by the funeral establishment representative who is executing this authorization to accept or decline embalming.

I declare under penalty of perjury that the foregoing is true and correct.
Should be Empty: