Rcsc Form Cr1006 - Request For Release Of Remains Form 2011 printable pdf download

SHERIFF-CORONER

COUNTY OF RIVERSIDE

STANLEY SNIFF

SHERIFF-CORONER

CORONER BUREAU – WEST

CORONER BUREAU - EAST

800 S. REDLANDS AVENUE PERRIS, CA 92570

47-225 OASIS STREET INDIO, CA 92201

PHONE: 951-443-2300

PHONE: 760-863-8311

INVESTIGATIONS FAX: 951-443-2303

FAX: 760-863-7031

MORGUE FAX: 951-443-2322

MORGUE FAX: 760-863-7530

TO: SHERIFF-CORONER, County of Riverside

Re: _____________________________________, Deceased – Coroner File # 2011- __ __ __ __ __

REQUEST FOR RELEASE OF REMAINS

I certify th at, pursuant to Section 7100, Heal th and Safety Code, State of Cal ifornia, that it is m y legal right to control the disposition of

the remains of the above named decedent. I hereby request that you release the remains in your custody to:

_______________________________ ______________________________________

________________

Name of Funeral Director/Mortuary

Mailing Address, City, State, Zip

Telephone Number

The person signing this request is liable for all damages caused by any untruthful statements contained in this document (Health and Safety

Code Secti on 7110 ). It is also a criminal offense to forge or knowingly file a false st atement wi th a government agency ( Penal Code

Sections 115 and 470).

SIGNED ____________________________________________ RELATIONSHIP ____________________________

ADDRESS __________________________________________ CITY / STATE ______________________________

TELEPHONE NUMBER _______________________________ DATE SIGNED _____________________________

PERSONAL PROPERTY ADVISEMENT

The Sheriff-Coroner may be in possession of personal property belonging to that of the decedent. Personal property in the posession

of the Sheriff-Coroner will be released to the Funeral Director/Mortuary Agent at the time that the remains are released unless specified

below. Regardl ess, the Sheriff-Coroner will only maintain property for ninety days from date of death. Property shall be disposed of

after the ninety-day period.

I elect to pick up the personal property from the Sheriff-Coroner within the ninety-day period. I understand

that property not picked up within the time period will be disposed of. Call to make an appointment for release.

Signed: _______________________________________________________________________________________

FUNERAL DIRECTOR OR AGENT

I CERTIFY THAT I HAVE EXAMINED AND INITIALED TOE TAG # ______________ WHICH BEARS THE NAME OF

THE ABOVE NAMED DECEASED AND HAVE RECEIVED THE REMAINS.

I HAVE ALSO RECEIVED THE FOLLOWING ITEMS:

_______PERSONAL PROPERTY

_______ CLOTHING

INITIAL

REPRESENTATIVE _____________________________ SIGNATURE ____________________________

NAME

RELEASED BY: ________________________________ DATE/TIME ____________________________

NAME / TITLE

RCSC Form CR1006

Revised 07/2011

Rcsc Form Cr1006 - Request For Release Of Remains Form 2011

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