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Hennepin County, Minnesota

Anonymous

Next of kin (NOK) relinquishment of rights to make funeral arrangements

ME #

Name of deceased

Relinquishment of rights to make funeral arrangements

I do hereby state that I relinquish my rights to make funeral arrangements. If no one comes forward to make arrangements and take financial responsibility, I understand that the Medical Examiner's Office will determine the final disposition of the remains and they will contact a local funeral home for cremation or burial.

I will make funeral arrangements for the final disposition of the remains.

Yes

I will be financially responsible for the final disposition of the remains.

Yes

I will cooperate with the agency handling the disposition to provide information for the death certificate.

Yes

I will agree to provide my signature for cremation if that is to be the final disposition.

Yes

I will allow my name to be given to the party making the final arrangements.

Yes

I will claim property (excluding cash) and clothing retained by Medical Examiner's Office and understand unclaimed property will be disposed of according to policy.

Yes

I will relinquish my right to make funeral arrangements to a specific person.

Yes

Name of person(s) who will make arrangements

Relationship to decedent

Address

City

State

Zip Code

Phone number

Next of Kin information

Name

Relationship to decedent

Address

City

State

Zip Code

Phone number

Signature

Date signed

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Hennepin County, Minnesota