Medical Examiner Cremated Remains Request

Medical Examiner Cremated Remains Request

The Delaware County Medical Examiners Office
Name of the Decedent*
Case Number of the Decedent*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Name of Next of Kin*

First NameLast Name
Relationship to the Decedent*
Copy of Next of Kin's Driver's License*

Cancelof
Authorization for Pickup of Remains
Decedent Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age/Race/Gender/Marital Status*
Date of Death*

MonthDayYear
Date
I Name*, bearing the relationship of Relationship* to the above- named decedent. I am the legal next-of-kin/person to him/her. I wish to acquire the remains of First Name Last Name . I understand that there is a fee for the remains.

I also understand that Delaware County is not responsible/liable for the remains once the decedent remains have been released from Delaware County's custody.
Signature*

Clear
Should be Empty:

Authorization for Pickup of Remains