HGR, AGR or Fetal Death Cremation Permit Form

HGR, AGR or Fetal Death Cremation Permit Form

The Delaware County Medical Examiners Office
*Use this form to request a cremation permit for decedents who are Humanities Gift Registry or Anatomical Gifts Registry donations or Fetal Deaths Only*
Cremation Authorizations Requested Quantity*
Decedent's Name 1*
Death Certificate 1*

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HGR, AGR Donation Form 1*

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Decedent's Name 2*
Death Certificate 2*

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HGR, AGR Donation Form 2*

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Decedent's Name 3*
Death Certificate 3*

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HGR, AGR Donation Form 3*

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Decedent's Name 4*
Death Certificate 4*

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HGR, AGR Donation Form 4*

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Decedent's Name 5*
Death Certificate 5*

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HGR, AGR Donation Form 5*

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Funeral Home Name*
Funeral Home Email*
example@example.com
Funeral Home Fax Number*
Please enter a valid fax number.
Funeral Home Phone Number*
Please enter a valid phone number.
In accordance with Acts 152 and 182, the funeral home listed above has contacted this office for permission to dispose of the remains of the above referenced decedent either by cremation, burial at sea or by a means as to be thereafter unavailable for examination.

This office has duly investigated the cause and manner of death and is satisfied to no further action, with regard to the remains of the deceased, is required by this office.

This office thereby authorizes the above referenced funeral home to cremate, bury at sea or otherwise legally dispose of the remains of the above referenced decedent, according to law.

Respectfully,

Jeffrey E. Lange
Administrator, Delaware County Office of the Medical Examiner
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