AUTHORIZATION TO RELEASE TO FUNERAL HOME/CREMATORY

AUTHORIZATION TO RELEASE TO FUNERAL HOME/CREMATORY
Decedent's Full Name
Date of Birth (If known):

MonthDayYear
Date
Date of Death

MonthDayYear
Date
I authorize the Delaware County Office of the Medical Examiner to release the decedent and any property to:
Funeral Home/Crematory*
Legal next-of-kin is determined by PA Chapter 21, Title 20, Interstate Succession.
By signing this Authorization to Release form, I affirm that I am the closest next-of-kin to the decedent unless otherwise specified below.

I am the sole legal next of kinTwo or more persons share equal kinship and are signing the releaseOther
Name

First NameLast Name
Signature 1

Clear
Date

MonthDayYear
Date
Relationship to Decedent
Name

First NameLast Name
Signature 2

Clear
Date

MonthDayYear
Date
Relationship to Decedent
Should be Empty: