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McCOY & HARRISON
FUNERAL HOME, INC.

4918 Martin Luther King Blvd.• Houston, TX 77021
Phone (713) 659-7618 • Fax (713) 748-7122
www.mccoyandharrison.com

State of Texas

County of Harris

Before Me, the undersigned authority, on this date, personally appeared the undersigned Affiant who after being duly sworn by me did deposeth and sayeth:

I, ,

Am the of

Race: Sex: Age:

I HEREBY authorize McCoy & Harrison Funeral Home, Inc:

To Recover the body of the deceased from , and direct McCoy and Harrison Funeral Home to transport the remains of the deceased to their location at 4918 Martin Luther King Blvd. Houston, TX 77021.

The undersigned Affiant acknowledges that he/she is the legal next of kin and authorizes the above funeral home to release the decedent and all his or her personal effects in possession. I (We) do agree to indemnify and hold harmless all funeral home parties from any and all loss, costs, actions, or damage which they may suffer as a result of such said release.

Affiant
Please sign at the bottom part of this document.

Witness
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This Instrument was sworn to and subscribed before me this December 21, 2024

(SEAL} Notary Public in and for Harris County, Texas

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Timestamp

Audit

March 22, 2022 9:59 pm CST

McCoy & Harrison Authorization Release Form Uploaded by Brandon Lee - bayne@baynedm.com IP 112.204.120.74

March 22, 2022 10:01 pm CST

Crystal McCoy - crystal@mccoyandharrison.com added by Brandon Lee - bayne@baynedm.com as a CC'd Recipient Ip: 112.210.228.53

March 22, 2022 10:01 pm CST

Brandon Lee - brandon@mccoyandharrison.com added by Brandon Lee - bayne@baynedm.com as a CC'd Recipient Ip: 112.210.228.53

McCOY & HARRISON FUNERAL HOME, INC.

McCOY & HARRISON
FUNERAL HOME, INC.