Authorization to Remove Human Remains
and to Certify Next of Kin

Pursuant to your rules and regulations, I authorize the release of the human remains of:

First Name:
Middle Name:
Last Name:

To Cremation Society of Illinois. I am the nearest next of kin and declare by my signature below that I have full right to authorize this release, (i.e., Cremation Society of Illinois, its agents, and the hospital or convalescent hospital) where the death occurred, and its agents and any other parties.

I further certify that no other relative or party in interest has objected to this cremation.
I authorize embalming (if required / additional charge). Yes No
I authorize minimal preparation for viewing (additional charge). Yes No
I authorize DNA retrieval(additional charge). Yes No
I authorize taking a thumbprint (crematory will retain). Yes No

Next of Kin Information

Relationship:
Address:
City:
State:
Zip:
Phone:


The printed form must be notarized prior to submitting it to
Cremation Society of Illinois, Inc.