McCoy & Harrison Funeral Home

Harris County (HCIFS) Authorization of Next of Kin Release Form


Authorization of Next of Kin to Release Decedent/Personal Effects to Funeral Director

In accordance with state law, the Harris County Institute of Forensic Sciences (HCIFS) will perform an inquest or autopsy to determine the cause and manner of death of the decedent. If an autopsy is performed, certain organs and tissue are removed for necessary examination and testing. Upon completion of examination and testing, any organs and tissue kept by the HCIFS will be disposed of in accordance with health and safety guidelines.  

 

Case number: Name of Decedent:

Priority Class of Next of Kin as defined by Texas Health & Safety Code §711.002 

  1. PERSON DESIGNATED IN A WRITTEN INSTRUMENT SIGNED BY THE DECEDENT; 
  2. DECEDENT’S SURVIVING SPOUSE; 
  3. ANYONE OF THE DECEDENT’S SURVIVING ADULT CHILDREN; 
  4. EITHER OF THE DECEDENT’S SURVIVING PARENTS; 
  5. ANYONE OF THE DECEDENT’S SURVIVING ADULT SIBLINGS; or 
  6. ANY ADULT PERSON IN THE NEXT DEGREE OF KINSHIP IN THE ORDER NAMED BY THE LAW TO INHERIT THE  ESTATE OF THE DECEDENT  

Release of Decedent/Personal Effects and Next of Kin Acknowledgement 

I, , bearing the relationship of  attest that I am the legal next of kin, as defined above by Texas Health & Safety Code §711.002 and that there is  no other person with a priority of right to control the disposition of the decedent’s remains listed before me.  

I hereby authorize the HCIFS to release the decedent named above and any personal effects in the possession of  the HCIFS to Funeral Home / Transport Service or its agent upon  presentation of this completed document and government-issued photo identification. The transport agent agrees  to follow all requirements of Texas Occupations Code §651.401 

THIS IS A GOVERNMENTAL RECORD AS DEFINED BY TEXAS PENAL CODE SECTION 37.10. BY SIGNING THIS DOCUMENT, I REPRESENT  THAT I AM THE NEXT OF KIN AND THERE IS NO OTHER PERSON WITH A PRIORITY OF RIGHT TO CONTROL THE DISPOSITION OF THE  REMAINS LISTED BEFORE ME. I AGREE TO INDEMNIFY AND HOLD HARMLESS HARRIS COUNTY, ITS OFFICERS, AGENTS AND  EMPLOYEES FROM ALL CLAIMS OF ANY CHARACTER, TYPE OR DESCRIPTION, INCLUDING BUT NOT LIMITED TO NEGLIGENCE, GROSS  NEGLIGENCE, AND/OR WILLFUL AND MALICIOUS CONDUCT AND RELEASE ANY PERSON WHO ACTS IN RELIANCE ON THIS DOCUMENT  FROM ANY LIABILITY, AND ACKNOWLEDGE THAT I AM LIABLE FOR ALL DAMAGES THAT RESULT, DIRECTLY OR INDIRECTLY, FROM  MY REPRESENTATIONS AND SIGNATURE. ANY DISPUTE AMONG THE DECEDENT’S NEXT OF KIN CONCERNING THE RIGHT TO CONTROL  THE DISPOSITION OF DECEDENT’S REMAINS MUST BE RESOLVED AMONG THOSE PERSONS BY A COURT OF COMPETENT JURISDICTION.  THIS INDEMNITY AND RELEASE IS BINDING ON ME, MY FAMILY, ESTATE, HEIRS AND ASSIGNS. 

 

Next of Kin Signature: Please sign at the bottom part of the document. 
Date Signed: November 30, 2020  Next of Kin Contact Number:

Next of Kin Address:  

 

Witness Name:

Witness Signature: Please sign at the bottom part of the document.  
Date Signed: November 30, 2020
Witness Contact Number:

Witness Address:  
Revised 01/2020

1861 Old Spanish Trail, Houston, Texas 77054 | (832) 927-5000 | ifs.harriscountytx.gov 

Leave this empty:

Signature arrow

Signed by Brandon Lee
Signed On: November 18, 2020

McCoy & Harrison Funeral Home https://www.mccoyandharrison.com
Signature Certificate
Document name: Harris County (HCIFS) Authorization of Next of Kin Release Form
lock iconUnique Document ID: 05d5a201e1be69c1a39290b6846710eedb228349
Timestamp Audit
November 16, 2020 7:39 am CSTHarris County (HCIFS) Authorization of Next of Kin Release Form Uploaded by Brandon Lee - bayne@baynedm.com IP 110.54.240.123