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48271 Van Dyke Ave unit #2
Shelby Township
,
MI
48317
(586) 580-9371
www.MacombCoCremation.com
General Release Form
Please release the human remains of
To Macomb County Cremation Services
Signature**
*
Name
*
First
Last
Relationship:
*
Phone
Email
*
Date
*
MM slash DD slash YYYY
**the the above signed represents that he/she has the right to make such authorization and agrees to hold the above-named entity and the MacombCoCremation, Gramer Funeral Home, Diener Chapel Inc. harmless from any liability on account of this authorization. By signing my name, I am agreeing to be bound by this authorization.
Date of Death
*
MM slash DD slash YYYY
Date of Birth
*
MM slash DD slash YYYY
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