DCOME 100231 Authorization to Relinquish Rights Electronic Version

COUNTY OF DELAWARE
AUTHORIZATION TO RELINQUISH RIGHTS FOR DISPOSITION
Decedent Name*
Date of Birth

MonthDayYear
Date
Age/Race/Gender/Marital Status of decedent.
Date of Death

MonthDayYear
Date
Medical Examiners Office Case Number (OPTIONAL)
Full Name of Next-of-Kin*
Full Name of Next-of Kin
Your relationship to decedent*
Relationship to Decedent
, bearing the relationship of to the above-named decendent. I am the legal next-of-kin, and I cannot bear the financial responsibility for the disposition of the body. By way of my signature on this document, I cannot assume the financial responsibility associated with the final arrangement. I am not disclaiming interest in the Estate.

I authorize the Delaware County Office of the Medical Examiner to arrange for the cremation of the remains of the above named decedent.
I understand that any present or future claims on the body or cremains of the abovenamed decedent have been waived pursuant to this authorization for final disposition*
Please initial
Signature*

Clear
Date

MonthDayYear
Date
Please upload a copy of your state issued identification*

Cancelof
Should be Empty: