Application To Disinter Body
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6Probate Court of Cuyahoga County, Ohio
Anthony J. Russo, Presiding Judge
Laura J. Gallagher, Judge
IN RE _____________________________________________________________ , DECEASED
CASE NUMBER:______________________________________
APPLICATION TO DISINTER BODY
[R.C. 517.24]
I, ________________________________________ , hereby make application to disinterment and removal of the remains
of the dead body of: _____________________________________ now lying in ___________________________________
Cemetery located at _______________________________ who died on the ________ day of ______________________ , _____,
the cause of death being : ______________________________________________________________ . The body is to be
reinterred at _____________________________________________ located at ____________________________________ .
Relationship of Applicant to Deceased ________________________________________________ .
The applicant represents to the Court that he or she is eighteen years of age or older and of sound mind; and that he or she
G
G
did
did not assume responsibility for the funeral and burial expenses of the decedent.
OATH
I, __________________________________ being first duly sworn that the foregoing facts are true and correct.
______________________________________________
_______________________________________________
Date Signed
Signature
______________________________________________
_______________________________________________
Area Code / Phone Number
Address
County of _____________________________________
State of _______________________________________ SS:
Sworn to and subscribed before me a notary public on this ______________________ day of ______________________
_______________________________________________
Notary Public / Deputy Clerk
Form 21.0 - Application to disinter body
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