Davenport Family

Davenport Family

Funeral Homes & Crematory 149 West Main Street Barrington, IL 60010 (847) 381-3411

419 East Terra Cotta Avenue Crystal Lake, IL 60014 (815) 459-3411

941 South Old Rand Road Lake Zurich, IL 60047 (847) 550-4221

We have an onsite crematory; your loved one will never leave our entrusted care.

To Whom It May Concern: I give my authorization for Davenport Family Funeral Homes and Crematory, or their agents, to: __________ Remove from_________________________________________ Facility Name __________ Embalm __________ Prepare un-embalmed remains (for identification/private viewing) Make arrangements for:

__________ Burial

__________ Cremation

______________________________________ (Printed Name of Deceased)

My signature below attests that I have full authority for the disposition of the deceased and no other survivors with the right to disposition will contest. _______________________________________ (Authorizer Printed Name)

_______________________________________ (Authorizer Address)

_______________________________________ (Authorizer Signature)

________________________________________ (Witness Signature)

________________________________________ (Witness Printed Name)

_________________________________ (Relationship to deceased)

_________________________________ (Authorizer Phone)

_________________________________ (Date Signed)

_________________________________ (Date Signed)