Request for Service Release

I,
,
of
hereby release his/her remains to Funeral Home (contracted funeral home for The Pennsylvania Cremation Society) for transportation and limited preparation for final disposition.
Time

: Hours

Minutes

AM/PM
Date
MM slash DD slash YYYY
Digital Signature

Please type your full, legal name.
Digital Signature

Please type your full, legal name a second time.
Funeral Home Staff

___________________________________________
signature
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