Form Cme 19P – Fill Out and Use This PDF

OFFICE OF THE CHIEF MEDICAL EXAMINER

CREMATION PERMIT APPLICATION (CME-19P)

STATE OF OKLAHOMA--BOARD OF MEDICOLEGAL INVESTIGATIONS

APPLICATION

RESIDENCE ADDRESS --

Street and Number

City or Town

County

State

LOCATION OF DEATH --

Hospital or Other Institution

City or Town

County

DATE OF DEATH

TIME OF DEATH

(If not in either, give address)

APPLICANT -- (Typed of Printed Name)

ADDRESS OF APPLICANT

RELATIONSHIP TO DECEASED

FUNERAL DIRECTOR IN CHARGE OF ARRANGEMENTS

NAME AND LOCATION OF CREMATORY OR OTHER FACILITY

DISPOSITION OF REMAINS -- Cremation, burial at sea, storage, ot other (specify)

I hereby certify that I am the person having the legal authority to dispose of the remains of the above-named decedent and that the application is made herewith for permission to dispose of the body.

WITNESS (Signature)

APPLICANT (Signature)

I hereby certify that I have investigated the death of the above-named individual in accordance with the provisions of Title 63 OS 1971, Sections

931-955, as amended. In my opinion, the cause of death is:

and the manner of death is:	Natural	Pending
	Suicide	Accident
	Homicide	Unknown

In accordance with Title 63 OS 1971, Section 1-329, as amended, permission for disposal is hereby granted.

*THIS PERMIT IS NOT REQUIRED FOR TRANSPORT OUT OF STATE

DATE

COUNTY OF APPOINTMENT

MEDICAL EXAMINER (Signature)

VALID ONLY WITH ASSIGNED PERMIT NUMBER AND WITH SIGNATURE OF MEDICAL EXAMINER

FUNERAL DIRECTOR INSTRUCTIONS

1.Complete upper portion of application including necessary signatures.

2.FAX cremation application and information sheet to the appropriate medical examiners office. I.E. Oklahoma City or Tulsa. If FAX is not available, contact appointed office for instructions.

3.The medical examiners office will complete the application, including the permit number and doctors signature.

4.The medical examiners office will FAX the funeral home the completed cremation application.

5.The funeral home may proceed with cremation and present the completed facsimile cremation form to crematory.

6.The medical examiners office will mail the funeral home the original death certificate and a copy of the cremation permit to be filed with the local registrar.

7.The funeral home is required to submit the $100.00 fee to the appropriate medical examiners office within 48 hours.PLEASE INDICATE DECEDENTS NAME AND

PERMIT NUMBER WITH PAYMENT.

NOTE: ALL CREMATIONS ARE INVESTIGATED BY THE MEDICAL EXAMINERS OFFICE 1.E. OKLAHOMA CITY OR TULSA. DO NOT CONTACT LOCAL MEDICAL EXAMINERS

This form may be reproduced by the funeral home.

CME -- 19P (7-93)