Funeral Associate

Legacy Funeral Services

Authorization for Release of Human Remains

I, jessica frost represent that I am the nearest degree of (Printed Name of next of Kin)

kinship, and am duly authorized to release the remains of __rebecca ann musser (Name of Decedent)

from sparrow hospital to Legacy Funeral Services (Place of Death/Medical Examiners/Associate Funeral Home)

to care and prepare for final disposition.

I acknowledge, and agree that this release authorization permits the funeral home to use the services of other funeral homes/affiliates, or other independent contractors in connection with the transfer of the decedent from the place of death.

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.

Executed on or about this __july day of 17 20 21

Decedent’s Date of Birth 02-06-1953 Decedent’s Date of Death 07-17-21 Decedent’s Race/Sex white/female Decedent’s Social Security # Signature jessica frost Date 7-17-21 Printed Name jessica frost Relationship to Decedent daughter Witness

Toll Free: 1-800-***-**** Toll Free Fax: 1-800-***-**** Email: *****@*************.***