Release Authorization

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We are committed to providing information, options and guidance with the highest level of competence, courtesy, and compassion.

10684 Southern Maryland Blvd. Dunkirk, Md. 20754

henrywilliamfs@gmail.com
(301) 447-9459

Name of Decedent

First Name

Last Name

Date of Birth

YYYY

Date of Death

YYYY

Case ID#

Name of Funeral Home

I, the undersigned, hereby authorize and request

Release/transfer the remains of the Decedent to

Written Authorization and/or Confirmation of Verbal Authorization:

I acknowledge and agree that this release authorization permits the Funeral Home to use the services of other funeral home/affiliates or other independent contractors in connection with the transfer of the Decedent from the place of death or Funeral Home. I represent that I have legal authority to give this authorization. I agree to indemnify and hold harmless the Funeral Home, its affiliates and their agents and employees from any and all liability or claim which may arise as a result of this release authorization.

Name of Authorized Representative

Relationship to Decedent

Signature of Authorized Representative

Date

YYYY

We are always here for you. Whether you need immediate help, or talk to one of our Directors, we’re only a phone call away.

Release Authorization

We will help you plan a celebration that is as unique