Ex Parte Petition For Court Order To Release Remains Of A
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1
2NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY:
STATE BAR NUMBER
FOR COURT USE ONLY
TELEPHONE NO.:
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES
COURTHOUSE ADDRESS:
MATTER OF:
______________________________________________________________________________, Decedent
CASE NUMBER:
HEARING DATE:
EX PARTE PETITION FOR COURT ORDER TO RELEASE REMAINS OF A
DECEDENT
DEPT.:
TIME:
THIS EX PARTE PETITION IS ONLY TO REQUEST RELEASE OF THE REMAINS OF THE DECEDENT AND
DOES NOT CONTAIN ANY REQUEST TO ADMINISTER THE ESTATE OF DECEDENT.
1.
Petitioner, _____________________________________, requests an order from the Court
(Your Name)
authorizing him/her to claim the remains of the decedent _______________________________.
(Decedent’s Name)
2
Decedent died on: _______________________ at: ___________________________________
(Date)
(City and State)
Check one:
Decedent was a resident of the County of Los Angeles and his/her remains are in the
custody of the Los Angeles County Coroner or a hospital or mortuary located in Los
Angeles County.
Decedent was NOT a resident of the County of Los Angeles and his/her remains are in
the custody of the Los Angeles County Coroner or a hospital or mortuary located in Los
Angeles County.
3.
Street address, city, and county of decedent’s residence at time of death (specify):
4.
My relationship to the decedent is: __________________________________. [If you are not
related to the decedent by either blood or marriage, describe below how long you have known
the decedent and how you met (work, church, neighbor, etc.)]:
Ex Parte Petition for Order to Release Remains
PRO 017
Health & Safety Code § 7105
02/12
Page 1 of 2
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