Release of Cremated Remains Authorization 03-26-2018Release Authorization
Name of Decedent (the "Decedent') STANDKE, Virginia Corrine
(LAST, First Middle)
Date of Birth 5/29/1937 Date of Death 3/25/2018 Case ID#
Name/Loc# of Funeral Home (the "Funeral Home") National Cremation Society
1, the undersigned, hereby authorize and request Chaska Heights
(Name of Place of Death or Fun Tat Home with Custody of Decedent)
Chaska, MN
(Address of Place of Death or Funeral Home with Custody of the Decedent)
release/transfer the remains of the Decedent to National Cremation Society
(Name of Funeral Home or Institute Assuming Custody of Decedent)
National Cremation Society - Personal Care Center, 1485 White Bear Ave. St. Paul MN, 55106
(Address of Funeral Home or institute Assuming Custody of Decedent)
I acknowledge and agree that this release authorization permits the Funeral Home to use the services of other
funeral home/affiliates or other independent contractors in connection with the transfer of the Decedent from the
place of death or Funeral Home.
I represent that I have legal authority to give this authorization. I agree to indemnify and hold harmless the
Funeral Home, its affiliates and their agents and employees from any and all liability or claim which may arise as
a result of this release authorization.
William Standke
Print Name of Authorized Representative
Representative
Abby Schilling
Print Name o////f����Funeral Home Representative
Signatureof Funeral Horl Riepresentative
If authorization is oral, complete the followine:
Authorization Received from
Phone Number
By (Print Name)
Received By (Signature)
Husband
Relationship to Decedent
3/26/2018
Date
Mortician
Title
3/26/2018
Date
Relationship to Decedent
Date and Time Obtained
Version 1.0 FIN-CS027 Modified: 04/15/2015
Form Owner (Department): Operations Support ® 2015 SCI Funeral & Cemetery Purchasing Cooperative, Inc.