Authorization - Nancy Chambers

Name of decedent:  [esiggravity formid="25" field_id="2" display="value" ] 

Name of person identifying decedent:   [esiggravity formid="25" field_id="3" display="value" ] 

Relation to decedent:    [esiggravity formid="25" field_id="4" display="value" ] 

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

Signature of person identifying decedent:

Leave this empty:

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Signature Certificate
Document name: Authorization - Nancy Chambers
lock iconUnique Document ID: c2cc004f3113fbc39b7a2b05edeab74daa0053a2
Timestamp Audit
March 13, 2024 10:35 am CDTAuthorization - Nancy Chambers Uploaded by YellowRose Funeral Home - IP