Authorization To Embalm

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10684 Southern Maryland Blvd. Dunkirk, Md. 20754

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(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

I hereby authorize the Funeral Home, including its agents and associates, to embalm, care for and prepare for disposition of the body of the decedent, in accordance with its customary practices. I acknowledge and agree that this authorization permits the Funeral Home to use the services of independent embalmers, apprentices or student interns in connection with such embalming, care and preparation for disposition, provided that any person rendering such services is allowed to perform such work under applicable law. I further acknowledge and agree that the embalming, care, and preparation for disposition authorized hereby may be performed at the Funeral Home’s facility or at another facility equipped to provide such services. 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 associates from any and all liability or claims which may arise as a result of this AUTHORIZATION TO EMBALM or any action taken in accordance herewith.

Name of Authorized Representative

Relationship to Decedent

Phone

(###)

###

####

Date

YYYY

Signature of Authorized Representative

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

Authorization To Embalm

We will help you plan a celebration that is as unique