Deceased Information
From (Current Location)
Transfer To
Representative Details

I hereby certify that I am the of the above mentioned decedent of the above-named decedent and that this is your authority to make disposition of the decedent as above indicated.

I hereby certify that I have the right to make this authorization, and I agree to hold GOLDEN HAVEN MEMORIAL PARK, INC. free from any liability on account of said Exhumation.

I hereby certify that I am the owner of the above-described property and I hereby authorized the above re-interment and placement of a marker thereon and agree to the above instruction and authorization.


I hereby agree to the terms and conditions and consent to the collection, use and disclosure of all personal information I have provided hereunder for the purpose of Golden Haven services rendered and all other documents related hereto.