• AUTHORIZATION

  • I hereby designate the above-named funeral establishment to take change of funeral arrangements for:

  • , and I authorize the release and removal of the remains to said funeral establishment for the purpose of embalming.

    I represent that I am the next of kin, or am acting as an authorized agent for the next of kin.

  • CERTIFICATION OF ATTENDANCE AT FUNERAL SERVICE

  • I hereby certify that

  • attended funeral services for

  • Should be Empty: