Paternity specimen release

Legal representative

M. E. Case number

Decedent name

Date of death

Next of kin/Legal representative name

Relationship

I hereby give my consent for the release of blood and/or tissue samples from the decedent listed above as I am the next of kin/Legal Representative.

These samples, currently being held at the Hennepin County Medical Examiner’s Office, are to be released to a representative of a lab for the sole purpose of paternity studies.

NEXT OF KIN / LEGAL REPRESENTATIVE

Name

Relationship to deceased

Address

City

State

Zip Code

City, State, Zip Code

Email address

Confirm email address

Phone number

Check this box to send a copy of this form to another email address

Confirm email

Signature

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Date signed