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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