Travis County ME Release 8-14 - acremation.com Fun usiness to receive val _____ __ ___ ER’S OFFICE...
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D T _ a P A Z P A r a T S P R S DATE:____ This authoriz ___________ and Please comp Address: Zip Code: 78 Phone #: 5 Authorizatio remove the accordance The above na Signature:__ Print Name : Relationship SUBMIT THIS TRAV OF TH 1213 Sa Tel: (51 www.co ___________ zes the Medi __________ Capital lete Funeral 201 Vic 8753 512-428-823 on is also said decea with profes amed Funera ___________ __________ :_________ DOCUMENT VIS COUN HE MEDIC abine Street PO 2) 854-9599 F o.travis.tx.us/m __________ ical Examine ________, to M Home infor ctor Street 33 given to th ased to their ssional stand al Home is a __________ __________ ___________ TO THE MED NTY OFFI CAL EXA O Box 1748 A Fax: (512) 854 medical_examin ______ er’s Office, T o Mortuary Ser rmation belo City he above n r place of b dards. authorized to ___________ ___________ ___________ ICAL EXAMIN CE AMINER Austin, TX 7876 4-9044 ner FAX Travis Coun aCrem rvice, if appl ow: y: Au F named Fun business to o receive val ___________ ___ ___ NER’S OFFICE 67 X: (512 nty, Texas, to mation licable. ustin Fax #: 21 neral Home care for, a luables: ( ) ___________ E UPON REMO 2) 854- o release the Fu State: T 14-785-6163 e or its de and prepar Yes ( ) No __________ OVAL OF THE -9862 e remains of uneral Home TX 3 signated ag e for dispo ___________ E DECEASED e gents, to osition in ___
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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