Final Disposition Waiver printable pdf download

Final Disposition Waiver

Office of the District

I, _______________________________, hereby waive my right of final disposition,

Medical Examiner

(Legally Authorized Person)

DISTRICT ONE

of _______________________________, to _____________________________.

Andrea N. Minyard, M.D.

(Decedent’s Name)

(Appointed Name)

Chief Medical Examiner

Cameron F. Snider, M.D.

Associate Medical Examiner

I understand by waiving my rights I hereby release the Medical Examiner, Gulf Coast

Jeffrey B. Martin, R-MDI

Chief of Forensic

Investigations

Autopsy Physicians, PA., and its officers, directors, employees and agents, and

Director of Operations

Central Office

_______________ County, from any and all claims, losses, or damages which the

5151 North Ninth Avenue

Pensacola, FL 32504

(850) 416-7200 – Office

undersigned or any of the heirs, beneficiaries, representatives or successors of the

(850) 416-6475 – Fax

Sub-Office

Decedent may have against or be entitled to recover as a result of waiving my final

206 Staff Drive

Ft. Walton Beach, FL 32548

(850) 651-7771 – Office

disposition rights.

(850) 651-7775 – Fax

Signed this ___________ Day of _________________________, 2007

_________________________________________________________

(Signature of Legally Authorized Person)

Witnessed this ________ Day of _________________________, 2007

_________________________________________________________

(Signature of Witness)

______________________________

________________________

(Printed Name of Witness)

(Telephone Number)

Final Disposition Waiver