Authorization to Relinquish Rights for Personal Effects

Authorization to Relinquish Rights for Personal Effects

The Delaware County Medical Examiners Office
Decedent Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age/Race/Gender/Marital Status:
Date of Death

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I name , bearing the relationship of relationship to the above-named decedent, am the next-of-kin or closest relative.
Select One
Select One
Decedent’s personal effects to be turned over to
Signature
Should be Empty: