AUTHORIZATION RELEASE FORM
Please print Owner's name clearly
PET ID:
107840D70AB2
REQUESTED ON: Oct, 18th, 2021
PRIVATE CREMATION
000Z - Urn, Bamboo, S
| ALTERNATE URN, JEWELRY CODE, OR SPECIAL INSTRUCTIONS |
Patient name: Rocco
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FOLD HERE
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| HOSPITAL: Farview Animal Clinic | ACCOUNT: farview-animal-clinic | |
| OWNER: Christine Udis | ||
| PHONE: (201) 937-8118 | ||
| STREET: 145 Arnot Place | ||
| CITY: Paramus | STATE: NJ | ZIP: 07652 |
| CREMATION ID: 107840D70AB2 | Christine Udis | |
| PET NAME: Rocco | M/F: M | LBS: 5 |
| BREED: CAT | COLOR: Black/Gray/Brown | |
As the owner or owner's authorized representative, I choose the above as final disposition for my pet. EUTHANASIA RECORD: As the owner or owner's authorized representative, I certify that my pet has not bitten a person or another animal within the last ten (10) days, is not under quarantine and to the best of my knowledge has not been exposed to Rabies, I give my veterinarian authority to proceed with euthanasia.
SIGNATURE
Individual cremains are carefully prepared and returned to you with a beautiful certificate of cremation.
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