Affidavit of Religious Beliefs

Pursuant to Minnesota Statute, Section 390.11, Subd. 2b, I hereby execute this affidavit, affirming my loved ones objection to an autopsy on religious grounds.

By completing this affidavit, I am affirming that an autopsy examination is contrary to my loved one’s religious beliefs. I understand that by honoring my loved ones religious right, the manner and cause of death may remain Undetermined. As a result of this religious objection, I understand that the Medical Examiner is not liable in any action for the failure to perform an autopsy. As the legal representative I will assume responsibility for the lawful disposition of the body of the deceased.

Decedent name

Date of birth

Religious affiliation

Describe the religious basis for objection to autopsy

Name of legal representative completing this form

Relationship to the deceased

Phone number

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Signature

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Date