Release Form Authority To Release Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. To: The Director of Medical Services Of (Hospital) *I AM THEPersonal RepresentativeSenior available Next Of Kin and the person responsible for making funeral arrangements THE NAME the NAME of person authorised to arrange the funeral. *DECEASED Full Legal NameDECEASED Date of BirthDECEASED Gender *SelectMaleFemaleIndeterminateDECEASED Last Residential AddressAuthorise KILLICK FAMILY FUNERALS to take possession of the body of the deceased, for the purpose of conducting funeral arrangements.Name of Person SigningDate Signature Clear Signature I acknowledge Queensland State Laws will accept this communication as containing my signature within the meaning of the Electronic Transactions (Qld) Act 2001.Submit