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Jan, 27. 2020 3: 52PM No. 1135 P. t <br />AUTHORIZATION FOR THE RELEASE OF REMAINS <br />IN THE CUSTODY OF THE CORONER <br />"-flut <br />MERCADO SEGURA A. <br />---~ <br />, Coroner Fe1 -------..-,,a <br />The fee of $318.~0 !s.~eiffu recover the cost of transportation and atorage of human remains Incurred by lhe Orange <br />County Cor~ce. This fee wes adopted by the Orange County Board cf SupaJVlaora on August 8, 2006 per <br />Ordlnance1i06-007, and aulhorlzed by Government Code Sections 27472 and 54985. Remittance Is expected upon <br />----m-tee ... ae of the decedent to the funeral home. <br />Tjesue(sllQmantsllBodv EIMi.1!00 BRlloll0o Notice <br />VI/her, a postmortem examination Is conducted to determine or confirm !he cause and/or manner or death In aocordance <br />With Callfomte GO\lemment Code Section 27491, llssue(s)/orgen(s)/body fll.dd(a) may be retained fc,r analysts andfor <br />evldentiary purpoae1 purauant to California Government Code Sections 27491.4 1 27491.45. Tlssue(s)/organ(s)/body <br />fluld(a) retalned at autopsy or as part of any Coroner lnveetlgaHve procedure will be disposed ot purauanl to Callfomla <br />Heallh & Safety Code Section 7054.4. You may Inquire about whether anything has been retained by the Coroner In this <br />regard. <br />Legal Next of Kin <br />I declare, under penalty of perjury, that I have the right to control dJspoeldon of the remains listed In accordance with Hee llh <br />& Sa1ety Code Section 7100 and I havs read the tissue/organ/body fluid retention notice, <br /> <br />P RQATION8HIP1 <br /> <br />9T : C : <br /> <br />LJ19al Representative (If not Next gf Kin} <br />RW!OPARTY: <br />P NT FULL N~MS OF 1'UT ORIZl!D P1'RT'fr '-TIOflSH P: <br />l'RINT <br />D0Rl!SlSI CITYl 8TATI!lllP CQ01!: TeLEFHONI!: ( <br />OP KIN: <br />Pmpertv Release <br />I declare, under penalty of per;ury, that I have lhe right to take custody of personal property of the above decedent <br />pursuant lo Callrornla Probate Code SecHon 8461. <br />MOTHER <br />'rFUl.l.NAMli: <br />,\0 • 1 I <br /> <br />RevllCld04/0112013