AUTHORIZATION TO EMBALM

AUTHORIZATION TO EMBALM

Telephone: (412) 331-5192

Fax: (412) 331-5820

EMAIL: CONROYFUNERALHOME@COMCAST.NET

William F. Conroy, Funeral Director / Supervisor

Patrick M. McGowan, Funeral Director

WILLIAM F. CONROY FUNERAL HOME, INC.

2944 CHARTIERS AVENUE  PITTSBURGH, PA 15204

WWW.WFCONROYFUNERALHOME.COM

The undersigned hereby authorizes William F. Conroy Funeral Home, Inc. and/or its agents, to care for,

embalm and otherwise prepare for burial and/or other disposition of the body of

I (we) hereby represent that I am (we are) of the same and nearest degree of relationship to the deceased and/or are legally

authorized or charged with the responsibility for such burial and/or other disposition.

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