The County of Galveston Medical Examiner's Office

1205 Oak St.
La Marque, TEXAS 77568
Phone: 409-770-5236 | Fax: 409-770-5239

Authorization to Release Body

First Name of Decedent: Middle Name of Decedent:

Last Name of Decedent:

Age: Race: White Black Hispanic Asian Other Sex: Male Female Non-Binary

Address of Decedent:

The Legal Next of Kin to the decedent according to the priority order list below:

Name of Legal Next of Kin: Relationship to Decedent: Spouse Parent Child Sibling Other

Address and Phone Number of Legal Next of Kin:

Authorization to Release Body to Funeral Home

Funeral Home Name:  Funeral Home Phone Number:

Funeral Home Fax Number:

Address of Funeral Home:

Signatures

Signature of Next of Kin: Date Signed:

Person Handling Remains:

Witness to Signature Above: Date Witnessed:

Legal Next of Kin Affirmation

With this signature, I attest and affirm that I (we) am (are) the legal next of kin according to the priority list below:

Priority Order of Next of Kin (Texas Health & Safety Code 711.002)

1. Person designated in a written instrument signed by the decedent Yes No - If Yes, please attach document(s)
2. The decedent's surviving spouse Yes No
3. Any one of the decedent's surviving adult children Yes No
4. Either one of the decedent's surviving parents Yes No
5. Any one of the decedent's surviving adult siblings Yes No
6. Any adult person in the next degree of kinship in the order named by law to inherit the estate of decedent Yes No - If Yes, please attach paperwork
7. Person(s) handling remains other than legal next of kin Yes No - If Yes, please submit a letter explaining the situation