What to expect if your Loved One is Identified:

Release Form if a Loved One is Identified:

Below you will find a form that you will have to fill out in the event that your Loved One is identified. The form outlines options we have in the event that additional Remains are found and identified. The options are as follows:

• I/WE DO NOT WISH TO BE NOTIFIED. I/WE ARE AUTHORIZING OFFICIALS TO DISPOSE OF SAID TISSUE(S) BY METHODS DEEMED APPROPRIATE BY SAID OFFICIALS.

• I/WE WISH TO BE NOTIFIED ANY TIME ADDITIONAL TISSUE(S) IS IDENTIFIED.

• I/WE WISH TO BE NOTIFIED OF ALL ADDITIONAL TISSUES ONE TIME AFTER THE MEDICAL EXAMINER DEEMS IT UNLIKELY THAT FURTHER TISSUE WILL BE IDENTIFIED.

If you would like to be notified at a particular time in the day or would like to designate an alternative representative to be notified in the event of an identification the Medical Examiner encourages updating your information by calling the DNA Hotline.

Actual Form Shown Below:
***(For exhibit only, not to be filled out)

OFFICE OF THE CHIEF MEDICAL EXAMINER

520 FIRST AVENUE, NEW YORK, NY 10016

CHARLES S. HIRSCH, MD CHIEF MEDICAL EXAMINER

TELEPHONE: 212-779-1710  FAX: 212-779-1223  24HR # 212-447-2030

THE NYC Official web site www.nyc.gov

RELEASE AUTHORIZATION

NAME OF DECEASED:  _________________________________________  ME # __________________________________

IN THE EVENT ANY ADDITIONAL TISSUES (S) ARE RECOVERD IN THE FUTURE AND ARE IDENTIFIED AS BELONGING TO THE ABOVE MENTIONED DECEASED, I/WE REQUESTE THE FOLLOWING:

1.  [  ]      I/WE DO NOT WISH TO BE NOTIFIED.  I/WE ARE AUTHORIZING OFFICIALS TO DISPOSE OF SAID TISSUE(S) BY METHODS DEEMED APPROPRIATE BY SAID OFFICIALS.

2.  [  ]      I/WE WISH TO BE NOTIFIED ANY TIME ADDITIONAL TISSUE(S) IS IDENTIFIED.

3.  [  ]      I/WE WISH TO BE NOTIFIED OF ALL ADDITIONAL TISSUES ONE TIME AFTER THE MEDICAL EXAMINER DEEMS IT UNLIKELY THAT FURTHER TISSUE WILL BE IDENTIFIED.

FOR OPTIONS 2 OR 3, PLEASE CHOOSE ONE OF THE FOLLOWING

                A.  [  ]  I/WE WISH TO BE NOTIFIED PERSONALLY ___________________________________________________________

                                                                                                                                                NAME AND PHONE NUMBER

                B.   [  ]  I/WE WISH NOTIFICATION THROUGH OUR FUNERAL DIRECTOR ________________________________________

                                                                                                                                                                                NAME AND PHONE NUMBER

                                                _____________________________________________________________________________________

                                                                                NAME AND PHONE NUMBER CONTINUED

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I/WE CERTIFY THAT I/WE HAVE READ AND UNDERSTAND THIS RELEASE AUTHORIZATION.  I/WE FURTHER STATE THAT I/WE ARE THE NEXT OF KIN, OR REPRESENT THE NEXT OF KIN AND AM/ARE LEGALLY AUTHORIZED , AND/OR CHARGED WITH THE RESPONSIBILITY OF BURIAL AND/OR FINAL DISPOSITION OF ABOVE SAID DECEASED.

SIGNED:  _______________________________                RELATIONSHIP TO DECEASED:  ______________________________________________

PRINT NAME:  __________________________                DATE SIGNED: _______________           TIME: ___________________________________

ADDRESS: _____________________________________________________________________________ PHONE: __________________________

SIGNED:  _______________________________                RELATIONSHIP TO DECEASED:  ______________________________________________

PRINT NAME:  __________________________                DATE SIGNED: _______________           TIME: ___________________________________

ADDRESS: _____________________________________________________________________________ PHONE: __________________________