Release/Remove Authorization

Release/Remove Authorization
Deceased Full Name

First NameLast Name
Date Of Birth

MonthDayYear
Date
Date Of Death

MonthDayYear
Date
I name (Relationship to Deceased) relation Authorize the Mustafa Center Funeral Home to remove the human remains of the deceased listed above from:
Name of Location
Address
Phone Number of Location
Please enter a valid phone number.Format: (000) 000-0000.
DEFINED NOK (NEXT OF KIN)

1: Written directive.
2: Surviving competent spouse, or domestic partner, as defined.
3: Sole surviving competent adult child or the majority of the competent surviving adult children.
4: Surviving competent parent or parents.
5: Surviving competent adult in the next degree of kindred.
6: Competent adult friend or volunteer.

The representative warrants and represents Mustafa Center Funeral Home that the relationship between the Decedent and he/she is as follows. The representative warrants and represents that by law he/she is the person who has a paramount right to arrange and direct the release and disposition of the remains of the Decedent listed above and that no other person has a superior right over him or her. Legal authority to arrange direct such services for the deceased is conveyed to the representative that has signed below.
Next of kin or Representative

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date

MonthDayYear
Date
Signature
Should be Empty: