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Pca
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_SETUP.1
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AUTOP.BLD
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1997-07-22
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53 lines
#600
@001 Enter the name of the DECEASED:
~Enter the name of the person who has died.
@002 Enter the name of the RELATIVE:
~Enter the name of the relative of the deceased who is giving
~permission for the autopsy of their relative.
@999 The relationship of the relative to the deceased is:
~Enter a description of the relationship between the relative
~and the deceased person. For example: father.
@010 Enter the agency to conduct the autopsy:
~Enter the name of the agency who will conduct the autopsy.
@003 Enter the state where signed:
~Enter the state where this permission is being signed.
@004 Enter the county where executed:
~Enter the county/parish where this permission is being signed.
#end control section
#600
CONSENT TO AUTOPSY
State of @003
County of @004
@002 hereby consents to the performance of an autopsy on @001,
the DECEASED, by @010. The relationship of @002 to the deceased
is @999.
Dated: ______________________
______________________________
@002
Sworn to and subscribed before me on the date stated above.
______________________________
Notary Public
My commission expires: