Order for Release | Boyd Funeral Home | Los Angeles CA funeral home and cremation
Order for Release

5

Please read and answer all the following questions before signing

Was the decedent legally married at the time of death?

Does the decedent have any living adult children?

Does the decedent have any living parents?

Does the decedent have a durable power of attorney / Advanced Health Care Directive under Probate Code Section 4600 et seq?

HEALTH AND SAFETY CODE § 7100: CUSTODY AND DUTY OF INTERMENT

"WARNING: The person signing this Order for Release is liable for all damages caused by any untruthful statements contained in this document. (Health and Safety Code Section 7110). It is also a criminal offense to knowingly file a false statement with a government agency. (Penal Code Section 115 and 470)"

1. An agent under a power of attorney for health care who has the right and duty of disposition under Division 4.7 (commencing with Section 4600) of the Probate Code;

2. The competent surviving spouse;

3. The sole surviving competent adult child of the decedent or, if there is more than one competent adult child of the decedent, the majority of the surviving competent adult children.

4. The surviving competent parent or parents of the decedent. If one of the surviving competent parents is absent, the remaining competent parent shall be vested with the rights and duties of this section after reasonable efforts have been unsuccessful in locating the absent surviving competent parent;

5. The sole surviving competent adult sibling of the decedent or, if there is more than one surviving competent adult sibling of the decedent, the majority of the surviving competent adult siblings;

6. The surviving competent adult person or persons respectively in the next degrees of kinship;

7. A conservator of the person or estate appointed under Part 3 (commencing with Section 1800) of Division 4 of the Probate Code when the conservator has sufficient assets.

8. The public administrator.

Therefore, please release the body upon completion of your death investigation of said deceased to:

Boyd Funeral Home

Name of Mortuary

323 756 8391

Mortuary Telephone Number

(Please Print Legibly)

IF THE LEGAL NEXT-OF-KIN IS NOT HANDLING, PLEASE ENTER NEXT-OF-KIN INFORMATION BELOW AND EXPLAIN WHY THEY ARE NOT HANDLING, ATTACH SUPPORTING AUTHORIZATION DOCUMENTS, E.G. WILLS, POWER OF ATTORNEY, FAXES, ETC.

Only to be filled out on the day of Pick up/Release.

Full Name

For Medical Examiner Personnel Only

Information Obtained by Mortuary From Family

If no, LAST KNOWN ALIVE


TERMINAL EVENT OR HOW DISCOVERED/KNOWN MEDICAL HISTORY, RECENT COMPLAINTS OR ILLNESSES AND PERTINENT INFORMATION:



ALL MEDICAL EVIDENCE LIST BELOW


DECEDENT PERSONALLY IDENTIFIED BY: / IDENTIFICATION HECHA POR:

(ENSCRIBA EN LETRA DE MOLDE)
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