Authorization for Removal of Decedent Form Authorization for Removal of Decedent Form Authorization for Removal of Decedent URLThis field is for validation purposes and should be left unchanged.The undersigned hereby authorize the above named funeral home to take charge of the funeral of: Name of the Deceased(Required)And I authorize the release and removal of the remains to the said funeral home. I represent that I am the next of kin or am acting as a duty authorized agent for the next of kin.SignedName(Required)Signature(Required)Your NameYour NameYour NameYour NameRelationship(Required)Phone #(Required)Email(Required) Co-SignedNameSignatureYour NameYour NameYour NameYour NameRelationshipPhone #Witness Name(Required)Signature(Required)Your NameYour NameYour NameYour NameDate(Required) Embalming AuthorizedFor Verbal (Telephone) AuthorizationAuthorization from:Recieved by:RelationshipPhone #Date Time Hours : Minutes AM PM AM/PM If further information or clarification is required please call 215-622-9770
