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Authorization to Release Body

Full Name of Decedent*:
*This name is what will appear on the death certificate

Age: Race: Sex:

Address of Decedent:

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

I (we), being the legal next of kin according to the priority list below, release the body to
Phone # of Funeral Home:
Fax # of Funeral Home:
Address of Funeral Home:

Signature of Next of Kin: Please sign at the bottom part of this document.

Date Signed: April 25, 2024

Witness to signature above:
Date Witnessed:

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

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

A person designated in a written instrument signed by the decedent

The decedent’s surviving spouse

Any one of the decedent’s surviving adult children

Either one of the decedent’s surviving parents

Any one of the decedent’s surviving adult siblings

Any adult person in the next degree of kinship in the order named by law to inherit the estate of the decedent

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

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I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

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Timestamp

Audit

November 15, 2020 8:56 am CDT

Galveston County Medical Examiners Release Form Uploaded by Brandon Lee - bayne@baynedm.com IP 112.204.120.74

March 21, 2022 7:48 am CDT

Crystal Mccoy - crystal@mccoyandharrison.com added by Brandon Lee - bayne@baynedm.com as a CC'd Recipient Ip: 112.210.228.53

March 21, 2022 7:48 am CDT

Brandon Lee - brandon@mccoyandharrison.com added by Brandon Lee - bayne@baynedm.com as a CC'd Recipient Ip: 112.210.228.53

March 22, 2022 9:28 pm CDT

Crystal Mccoy - crystal@mccoyandharrison.com added by Brandon Lee - bayne@baynedm.com as a CC'd Recipient Ip: 112.210.228.53

March 22, 2022 9:28 pm CDT

Brandon Lee - brandon@mccoyandharrison.com added by Brandon Lee - bayne@baynedm.com as a CC'd Recipient Ip: 112.210.228.53

The County of Galveston Medical Examiners Office

Authorization to Release Body

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

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