AUTHORIZATION TO RELEASE REMAINS

Eric L. Wilson Funeral & Cremation Services 4831 w Hallandale Beach Blvd Hollywood, Florida 33023 TEL: 954-391-8731 FAX: 954-367-5651 AUTHORIZATION TO RELEASE REMAINS

The undersigned hereby authorizes and requests release of the remains of the above named decedent to the following Funeral Home, including it's agents. Eric L Wilson Funeral & Cremation Services 4631 W Hallandale Beach Blvd, Hollywood FL

Phone number (954)391-8731 The above-named Funeral Home including it's agents, is hereby authorized to sign on the undersigned's behalf, any and all other authorizations that may be required to secure release of the above named decedent. The undersigned further represents that they have the legal right to make this authorization

To: Eric L Wilson Funeral & Cremation ServRe: (Name of Decedent) (Name of Funeral Home) ) or Do Not ( x ) request EMBALMING, which I understand is the replacement of body fluids by chemical preservatives, orthe application of chemical preservatives for the temporary preservation of the body. I further understand that EMBALMING IS NOT REQUIRED BY LAW. The undersigned hereby acknowledges and agrees that the foregoing Authorization to EMBALM permits the above-mentioned (FUNERAL HOME) to use the service of Independent Embalmers and / or apprentices or student interns in connection with the Embalming Care and Preparation for disposition of the decedent provided that any person rendering such service is allowed to perform such work under applicable law. The undersigned further acknowledges that the Embalming. Care and preparation for disposition of the decedent may be performed at the Funeral Home's facility or at another facility equipped to provide such services. The undersigned hereby agrees to INDEMNIFY and HOLD HARMLESS the Funeral Home, it's affiliates and their agents and employees from any and all Liability or Claims which may result from any action taken in accordance with this Authorization To Embalm.