Forensic Medical Management Services of Texas, P.A.
Release of Decedent and Personal Effects

www.forensicmedtx.com

Beaumont/Jefferson County | PO Box 20097 | Beaumont TX 77720 | Phone: (409) 726-2571 | Fax: (409) 726-2569

Forensic Medical of Texas has been requested to perform a complete autopsy on the decedent
named below to determine cause and manner of death. During autopsy certain organs are removed
and specimens may be retained as deemed necessary. Upon completion of examination and testing
FMMS has been authorized to dispose of any retained organs and tissues in accordance with local
health 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: September 14, 2026
Street Address:
City: State: Zip:
Contact Phone# (include area code): Alternate Phone #:

Witness Name: September 14, 2026
Street 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 identification
Funeral Home notified by : Date: Notified Date
F .H. Representative: Date Signed: September 14, 2026
FMMS Representative: FMMS Representative Date