Release Authorization - Northern Illinois Funeral Services, Inc.

Release Authorization Form

"*" indicates required fields

Option #1) If you would like to download a blank PDF to print, fill out, scan and email back to us, click here:

Option #2) If you would like to electronically fill out this form, please use the online form below. Fill out the following fields and then click the SUBMIT button at the bottom to send the form. A copy will be automatically emailed to us as well as to you. If you have any questions please feel free to call us for assistance.

The undersigned hereby authorize the release of the body of

Name of deceased*

First Last

Place or address of death*

to Northern Illinois Funeral Services and/or its agents. I/We hereby represent that I am (we are) of the same and nearest degree of relationship to the deceased and/or are legally authorized or charged with the responsibility for such burial and/or other disposition.

Name #1 (your name)*

Relationship to decedent*

Name #2

Relationship to decedent

Name #3

Relationship to decedent

Witness Name

Date

Your Email*

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