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AUTHORIZATION FOR RELEASE OF REMAINS OF THE DECEDENT

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AUTHORIZATION FOR RELEASE OF REMAINS
OF THE DECEDENT TO THE FUNERAL HOME
1. PARTIES:
“FUNERALHOME”:_____________________________________________________________
(NameofFuneralHome)
“REPRESENTATIVE”:_______________________________RELATIONSHIP:_____________
(NameofRepresentative)
(UseReverseSideforAdditionalNames)
“DECEDENT”:_________________________________________________________________
(NameofDecedent)
“INSTITUTION”:________________________________________________________________
(NameofInstitutionorPersonHoldingRemains)
2. RELATIONSHIP OF REPRESENTATIVE:TheREPRESENTATIVEwarrantsand
representstotheFUNERALHOMEthattherelationshipbetweentheREPRESENTATIVEandthe
DECEDENTisasfollows:(Checktheappropriatebox).
 Spouse
 Next-of-Kin(ClosestLivingRelative)
 PersonalRepresentativeoftheNext-of-KinwithwrittenauthorizationofNext-of-Kin
toactonhisorherbehalf.
 Other:
3. AUTHORITY OF REPRESENTATIVE:TheREPRESENTATIVEwarrantsandrepresents
toFUNERALHOMEthattheREPRESENTATIVEisthepersonortheappointedagentofthepersonwho
bylawhastheparamountrighttoarrangeanddirectthedispositionoftheremainsoftheDECEDENTand
thatnootherperson(s)hasasuperiorrightovertherightoftheREPRESENTATIVE.
4. RELEASE AUTHORIZATION:TheREPRESENTATIVEauthorizestheINSTITUTIONto
releasetheremainsoftheDECEDENTtotheFUNERALHOMEand/oritsagents.
5. INDEMNIFICATION:TheREPRESENTATIVEagreestoindemnifyandholdharmlessthe
FUNERALHOMEfromanyclaimsorcausesofactionarisingorrelatedinanyrespecttothisauthorization
forremovalortheFUNERALHOME’sreliancethereon.
12217.1©NationalFuneralDirectorsAssociation
DATE: SIGNATURE OF REPRESENTATIVE
___________________________ _____________________________________________
CHAPMAN FUNERAL HOMES 855-628-0447
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AUTHORIZATION FOR RELEASE OF REMAINS OF THE DECEDENT

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Completed 30 August 2021

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