ORDER FOR RELEASE OF REMAINS

TO: MEDICAL EXAMINER, COUNTY OF SAN DIEGO

RE: REMAINS OF ___________________________________________, ME CASE # ______________________

I certify that pursuant to Section 7100, Health & Safety Code, State of California, it is my legal right to control the disposition
of the remains referenced above, the location and conditions of interment, and arrangements for funeral goods and services
to be provided.  I certify further that I am acting in the capacity of (initial appropriate following category) Legal Next
of Kin ____ OR Executor/Executrix _____ OR Agent With Durable Power of Attorney for Health Care (must be for
Health Care) _____  OR other legal capacity____.  If acting in a capacity other than Legal Next of Kin, I have attached
a copy of the relevant appointing document(s).

I acknowledge that, pursuant to Sections 27472 and 54985, Government: Code, State of California, and Resolution
No. 99-260 of the Board of Supervisors, County of San Diego, I may be Liable for Medical Examiner fees of $173 for
transportation ($153) and body pouch ($20), and, if so, agree to pay said fees when invoiced.

Therefore, upon completion of your examination of the deceased please release the remains referenced above to the custody
of the service designated below.  If possible please (initial following choice) release _____ OR do NOT release _____ all
of the deceased's personal property in your care with the remains.  I understand that personal property can only be released
during regular working hours (8-5, M-F less holidays)

_________________________________________________________________________________________________
Print Name of Designated Mortuary, Cremation Society, or Disposition Service

__________________________________________                     __________________________________________
Print Name of Person Signing                                                         Signature

__________________________________________                     __________________________________________
Mailing Address of Person Signing                                                Date Signed

__________________________________________                     __________________________________________
City, State, Zip Code of Person Signing                                         City, State Where Signed

FOR MEDICAL EXAMINER DEPARTMENT USE ONLY