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\.; <br />Jan.27.2020 3:52 P~ No. 1135 P. 2 <br />AUTHORIZATION FOR THE RELEASE OF REMAINS <br />IN THE CUSTODY OF THE CORONER <br />I <br />t.a1t H1111 ■ofDIIGlld1nt l'lrtt Mlddl• lnldll Cclrl,n,rC'-# <br />MERCADO SEGURA MIGUEL A. 20-00372-MM t / <br />Coroner Fee <br />The ree of $318 .00 is assessed to recover the cost of transportation and storage of human remain& Incurred by the Orange <br />County Coroner's Office . This fee was adopted by the Orange County Board of Supervisors on August 8, 2006 per <br />Ordinance #06-007, and authorized by Government Code Sections 27472 and 549135, Remittance Is expected upon <br />release of the decedent to the funeral home. <br />T!ssue(s)/Organ(s)/Body Fluld(sl RetenUon Notice <br />When a postmortem e>eamlneHon le conducted to determine or conflnn the cause and/or manner or death In accordance <br />with Cellfomla Government Code Section 27491, lls:n1e(&}/organ(a)/body fluld(a) may be retained for analysis and/or <br />evldentlary purposes pursuant to California Govemmenl Code Sections 27491.4, 27491.45, Tlssue(s)/organ(s)/body <br />fluid(&) retained at autopsy or as pE1rt of any Coroner Investigative procedura will bi, disposed of pur&uanl to canrornla <br />Health & Safety Code Section 7054 .4, You may Inquire about whether anything has been retained by the Coroner In Ihle <br />regard. <br />Legal Next of Kin <br />I declare, under penalty of perjury, that I have the right to control djsposltion of the remain• listed In accordance with Heallh <br />& Safety Code Section 7100 and I have read the tissue/organ/body fluid retention noflco, <br />ORTJlARY <br />FATHER <br />Legal Representative (If not Next of Kin) <br />SIGNATUR& OF AUTHORIZl!D PARTY: <br />PRINT fV"-....... -• l'AIHYI RELA TIONStilP: <br />l'IIINT l'ULL ADDRE$$ 01' 1,VTHORIZED P11KTY UETOW: <br />ADORliSI: cnv: STATJ!IZIP 00D1!: '1ElliPHONE: t ) <br />Rl!AISON POlt Hl,NOUNO ti' NOT Nl!XT Of' KIN! <br />Property Release <br />I declare, under penalty of perjury, that 1 have the right to take custody of personal property of the above decedent <br />pursuant lo Canrornfa Probate Code Section 8461. <br />RELA TIONBHIPI FATHER <br /> <br />AODR : I <br /> <br />Revlaad D4/01/2013