Body Release Authorization Form
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1Body Release Authorization
Deceased (Full Name)
Date of Birth
Date and Time of Death
Age
Race
Sex
Next of Kin
Relationship to Deceased
I, the next of kin, hereby authorize the release of the Deceased’s body to the funeral home representative listed
below.
Next of Kin Signature
Date
Funeral Home
Representative
Phone Number
Fax Number
Address
Transportation Service
Phone Number
Person(s) Picking Up Bodies
Date and Time of Pickup
Funeral Home Representative Signature
Date
Hospital
Staff Representative
Case Number
Personal Effects
Date/Time of Release
Staff Representative Signature
Date
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