Authorization to Embalm

(Submission of this form constitutes Written Authorization)

Authorization is given to Hall Davis & Son Funeral Service, Ltd., including its agents, employees, trade embalmers, or any apprentices or students, (including those from a mortuary school, who are under the direct supervision of a licensed embalmer) whether at this location or another location to embalm the remains of the deceased.

The person submitting hereby represents that he/she or they have the legal right to make this authorization.

Title
MR MRS MISS MS DR

First Name *

Last Name *

Email Address *

Date *

Name of person making authorization *

Relationship *

I hereby give AUTHORIZATION to EMBALM *
Yes
No

the remains of: *