SHERIFF-CORONER
COUNTY OF RIVERSIDE

 
 

LARRY D. SMITH,
SHERIFF-CORONER
 

INVESTIGATIONS (WEST)
1420 CITRUS AVENUE
RIVERSIDE, CA 92507
PHONE: (909) 341-8836
FAX: (909) 275-8792
 

MORGUE
3610 11TH STREET
RIVERSIDE, CA 92501
PHONE: (909) 955-1520
FAX: (909) 955-1510
 

INVESTIGATIONS (EAST)
82-675 HIGHWAY 111, #20
INDIO, CA 92201
PHONE: (760) 345-4241
FAX: (760) 863-7031
 
TO: SHERIFF-CORONER, COUNTY OF RIVERSIDE

RE: __________________________________________________________, Deceased
                   "WARNING: The person signing this Request for Release of Remains is liable for all damages caused by any untruthful
                                          Statements contained in this document (Health and Safety Code Section 7110). It is also a criminal offense to knowingly
                                          file a false statement with a government agency. (Penal Code Sections 115 and 470)."

REQUEST FOR RELEASE OF REMAINS

I certify that, pursuant to Section 7100, Health and Safety Code, State of California, it is my legal right to select any funeral
director or disposition service.  Therefore, upon completion of your investigation of the death of the above named deceased,
please release the remains to:

_______________________________________________________________________
NAME OF MORTUARY

SIGNED _______________________________________________ RELATIONSHIP __________________________
ADDRESS _____________________________________ CITY _______________________ STATE ______________
TELEPHONE NUMBER _____________________________________ DATE SIGNED ________________________
REASON FOR HANDLING IF NOT NEXT OF KIN ____________________________________________________
________________________________________________________________________________________________

FUNERAL DIRECTOR / DISPOSITION SERVICE 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: _____ Death Certificate & Worksheet:_____ Deceased's Clothing
                                                                                                                              Initial                                                                          Initial

Representative (Print) ___________________________________ Signature ___________________________________

Released by __________________________________________ Date/Time ___________________________________