4918 Martin Luther King Blvd.• Houston, TX 77021 Phone (713) 659-7618 • Fax (713) 748-7122 www.mccoyandharrison.com
State of Texas
County of Harris
Before Me, the undersigned authority, on this date, personally appeared the undersigned Affiant who after being duly sworn by me did deposeth and sayeth:
Am the of
Race: Sex: Age:
I HEREBY authorize McCoy & Harrison Funeral Home, Inc:
To Recover the body of the deceased from , and direct McCoy and Harrison Funeral Home to transport the remains of the deceased to their location at 4918 Martin Luther King Blvd. Houston, TX 77021.
The undersigned Affiant acknowledges that he/she is the legal next of kin and authorizes the above funeral home to release the decedent and all his or her personal effects in possession. I (We) do agree to indemnify and hold harmless all funeral home parties from any and all loss, costs, actions, or damage which they may suffer as a result of such said release.
AffiantPlease sign at the bottom part of this document.
WitnessPlease sign at the bottom part of this document.
This Instrument was sworn to and subscribed before me this October 5, 2022
(SEAL} Notary Public in and for Harris County, Texas
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Document Name: McCoy & Harrison Authorization Release Form
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