– Body Release Form

Body Release Form

AUTHORIZATION TO REMOVE HUMAN REMAINS

Name of the Decedent

Name of the Decedent

First Name

First Name

Last Name

Last Name

Date of Death

Place of Death

Date of Birth

Name of Next of Kin

Name of Next of Kin

First Name

First Name

Last Name

Last Name

Relationship to the Deceased

Phone

I hereby affirm that I am the legal next of kin, or a duly authorized agent acting on behalf of the next of kin, and do hereby authorize the Islamic Center of Richmond / Al Firdous, a licensed funeral establishment, or its designated representative, to take custody of the decedent’s remains and to make all necessary arrangements pertaining to the funeral and burial.

Date

Signature *

If you are human, leave this field blank.

We love our families, we would like to hear from you about your needs and concerns. We will do our best to fulfill them.