Tarrant County Medical Form

OFFICE OF THE CHIEF MEDICAL EXAMINER

TARRANT COUNTY MEDICAL EXAMINER'S DISTRICT

200 Feliks Gwozdz Place

Fort Worth, Texas 76104-4919

Phone: 817-920-5700 Fax: 817-920-5713

Date:

Date

This authorizes the Tarrant County Medical Examiner's District, Fort Worth,

Texas, to deliver the remains of:

to the Complete Care Cremation, LLC funeral home. Please Complete the funeral home information below.

complete funeral home information below:

Authorization is also given to the above named funeral home, or its designated agents, to remove the said deceased to their place of business to care for, and prepare for disposition in accordance with professional standards.

Funeral home is authorized to receive valuables:

Signature

Printed Name

Relationship to deceased

Note: Cash over $50.00 must be picked up in person by decedent's next-of-kin.

ME-23 GPC-1953 Rev. 10/09

EMAIL TO: INFO@CREMATION-TX.COM