Travis County ME Release 8-14 - acremation.com Fun usiness to receive val _____ __ ___ ER’S OFFICE...

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Transcript of Travis County ME Release 8-14 - acremation.com Fun usiness to receive val _____ __ ___ ER’S OFFICE...

D T _a P

A

Z

P

Ara T S P

R S

DATE:____

This authoriz

___________and

Please comp

Address:

Zip Code: 78

Phone #: 5

Authorizatioremove the accordance

The above na

Signature:__

Print Name :

Relationship

SUBMIT THIS

TRAVOF TH1213 SaTel: (51www.co

___________

zes the Medi

__________ Capital

lete Funeral

201 Vic

8753

512-428-823

on is also said deceawith profes

amed Funera

___________

__________

:_________

DOCUMENT

VIS COUNHE MEDICabine Street PO2) 854-9599 F

o.travis.tx.us/m

__________

ical Examine

________, to M

Home infor

ctor Street

33

given to thased to theirssional stand

al Home is a

__________

__________

___________

TO THE MED

NTY OFFICAL EXAO Box 1748 AFax: (512) 854

medical_examin

______

er’s Office, T

o Mortuary Ser

rmation belo

City

he above nr place of bdards.

authorized to

___________

___________

___________

ICAL EXAMIN

CE AMINERAustin, TX 78764-9044 ner

FAXTravis Coun

aCremrvice, if appl

ow:

y: Au

F

named Funbusiness to

o receive val

___________

___

___

NER’S OFFICE

67

X: (512nty, Texas, to

mation licable.

ustin

Fax #: 21

neral Homecare for, a

luables: ( )

___________

E UPON REMO

2) 854-o release the

Fu

State: T

14-785-6163

e or its deand prepar

Yes ( ) No

__________

OVAL OF THE

-9862

e remains of

uneral Home

TX

3

signated age for dispo

___________

E DECEASED

e

gents, to osition in

___

MaryBeth
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MaryBeth
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Families: Please complete and fax back to aCremation at 214-785-6163. NOT the fax number below (it is for our use).
MaryBeth
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MaryBeth
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MaryBeth
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MaryBeth
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MaryBeth
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MaryBeth
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MaryBeth
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MaryBeth
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