Vital Statistic Form
NYC Funeral & Cremation Service Inc
Premier Funeral Cremation Service
Date of Death
Name of Decedent:
Printed Name of Designated Person to Receive the Cremains
The undersigned hereby confirms that he/she has given authorization to allow N.Y.C. Funeral & Cremation Service Inc. permission to remove the above named Decedent. The undersigned further acknowledges that he/she authorizes N.Y.C. Funeral & Cremation Service Inc. to cremate the Decedent. The undersigned acknowledges that he/she allows N.Y.C. Funeral & Cremation Service Inc. permission to give the cremains of the Decedent to the Designated Person listed below. The undersigned certifies that he/she further agree to hold N.Y.C. Funeral & Cremation Service Inc. harmless for any and all liability of said authorization.
Address of Designated Person to Receive Cremains (include apartment number), and phone number
Thank you for contacting us! If needed, you will hear back within 48-72 hours.
Printed Name of Person Authorizing this form, and relationship to Decedent
Address of Person Authorizing
N.Y.C. Funeral & Cremation Service Inc. RELEASE FORM: Authorization to Remove the Decedent, Cremate the Decedent, and Authorization to Give Cremains to Designated Person
Signature of Person Authorizing or Printed Name again confirms you agree to all of the above on form
NYC Funeral and Cremation Service Inc.
. All rights reserved.
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