2-HSS-26-033 - Indigent Burial - Appendix C - Next of Kin Authorization for Burial.docx
DOCX document 132 KB Posted
- Attached to
- INDIGENT BURIAL AND CREMATION SERVICES
- Solicitation number
- HSS-26-033
- Issued by
- Delaware
About this file
This is a Next of Kin Authorization for Burial form developed by the Delaware Health and Social Services Division of Social Services as part of the Indigent Burial and Cremation Services contract opportunity (2-HSS-26-033). The form serves as the authorization document that allows the Department of Health and Social Services to take charge of deceased individuals' remains for burial or cremation purposes. The form requires the signature of the surviving spouse, next-of-kin, or legal representative of the decedent and includes checkboxes to designate whether burial or cremation is the preferred method of disposition. By executing this authorization, the signatory consents to the Department disposing of the remains at a time, place, and manner determined solely by the Department and waives any right to direct the specific details of disposition.
The form includes attestation language confirming that the authorizing party has read and understands the authorization terms, possesses legal authority to authorize disposition of the decedent's remains, and acknowledges the Department's discretion in handling all aspects of the disposition process. The document requires signature, witness verification, and date completion before execution.
View the file
Other files
Show all 11
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Delaware Health and Social Services
Division of Social Services1 d
Appendix C Next of Kin Authorization for Burial
I hereby authorize and direct the Department of Health and Social Services to take charge of the remains of
________________________________________________________________, Decedent, (Name and DOB of Decedent) for the purpose of burial or cremation.
I, , am surviving spouse, next-of-kin, or legal representative of the Decedent.
I do voluntarily consent and authorize the Department of Health and Social Services and its employees, independent contractors, and agents to ☐bury ☐ cremate the Decedent. (Please check the appropriate box.)
I understand and agree that this consent and authorization permits the Department of Health and Social Services to dispose of the remains of the Decedent at a time, place, and manner to be determined by the Department of Health and Social Services and its employees, independent contractors, and agents. I hereby waive any right or claim I may have to direct the time, place, or manner of burial.
By signing below, I acknowledge I have legal authority to authorize disposition of the Decedent’s remains. I further acknowledge I read the above statements and understand their content.
Signature:
Witness:
Date:
image1.png image2.png
File details come from the government source that posted it. Updated .