Name of decedent:   

Name of person identifying decedent:    

Relation to decedent:     

I agree to identify the decedent through online identification. I acknowledge that I am the
next of kin, have viewed the photo online, and identified the photo as the decedent listed
above.

Date of identification:

Signature of person identifying decedent:

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Your legal name

Your email address

Please Confirm full name and signature.

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I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

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I agree that I am and I understand this is a legal representation of my signature

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Signature Certificate

Document name: Authorization - Jimmy Willeby, Jr.

Unique Document ID: d46385720148e68aae23ea8223a08fd6ed132b88

Build. Track. Sign Contracts.

Timestamp	Audit
June 25, 2023 2:30 pm CDT	Authorization - Jimmy Willeby, Jr. Uploaded by YellowRose Funeral Home - [email protected] IP 96.61.170.10

This audit trail report provides a detailed record of the online activity and events recorded for this document.

https://yellowrosecremation.com/

Audit Trail Serial# 38b7e62fea3462a055cfe7b86d4e318d