Beaumont-Jefferson County Medical Examiners Release Form
Beaumont/Jefferson County | PO Box 20097 | Beaumont TX 77720 | Phone: (409) 726-2571 | Fax: (409) 726-2569Tyler | 11980 Highway 155 North | Tyler TX 75708 | Phone: (903) 877-3800 | Fax: (903) 877-3880
Forensic Medical of Texas has been requested to perform a complete autopsy on the decedentnamed below to determine cause and manner of death. During autopsy certain organs are removedand specimens may be retained as deemed necessary. Upon completion of examination and testingFMMS has been authorized to dispose of any retained organs and tissues in accordance with localhealth and safety guidelines.
Case number: Name of the Decedent: I, , bearing the relationship of , acknowledge that I am the legal next of kin as defined by the Texas Health & Safety Code Section §711.002. I hereby authorize FMMS of TX to release the decedent named above as well as any and all personal effects not retained as evidence to (Funeral Home) or its agent or representative, for burial or other arrangements as may be requested by the family.
NOTE: Any photo or government identification will be retained and returned to the issuer.
Next of Kin Name: Date Signed: January 18, 2021Street Address: City: State: Zip: Contact Phone# (include area code): Alternate Phone #:
Witness Name: January 18, 2021Street Address: City: State: Zip: Contact Phone# (include area code): Alternate Phone #:
Complete the information below at the time of release• All persons arriving to transport decedents will be required to present a valid government-issued identificationFuneral Home notified by : Date: Notified Date F .H. Representative: Date Signed: January 18, 2021FMMS Representative: FMMS Representative Date
Leave this empty:
Your legal name
Your email address
Signed by Brandon Lee
Signed On: November 18, 2020
If you have questions about the contents of this document, you can email the document owner.
Document Name: Beaumont-Jefferson County Medical Examiners Release Form
Agree & Sign