Petition For Order Authorizing Disposition Of Unclaimed Body {CIV-714}

Page 1 of 2 CIV-714 (8/17)(cs) PETITION FOR ORDER AUTHORIZING DISPOSITION OF UNCLAIMED BODY AS 12.65.100 & 110 IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of: ) ) ) ) CASE NO. ) Deceased Person Date of Birth: ) DISPOSITION OF UNCLAIMED BODY Date of Death: ) (UNDER AS 12.65.100) ) I, the undersigned, swear or affirm under penalty of perjury that the following is true to the best of my knowledge and belief following diligent inquiry: 1. a. The death of the above-named person was was not reported to the office of the State Medical Examiner (SME) under AS 12.65.005. SME Case No. b.The office of the SME does not need the body for further examination. c. The death is not being investigated by police or prosecutors. The death is being investigated by the police, but the body is no longer needed and (name and title) of the 2.I reviewed the attached affidavit(s) in support of this petition. 3.The following items relating to the death investigation are attached: Copy of the death certificate (mandatory) Reports from law enforceOther: 4.I request a court order authorizing the Department of Health and Social Services toarrange for the PCremation of the body and the decent interment of the remains. The reason for cremation is American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 CIV-714 (8/17)(cs) PETITION FOR ORDER AUTHORIZING DISPOSITION OF UNCLAIMED BODY AS 12.65.100 & 110 5.Property. In addition to the property described on the supporting affidavit(s), the following property belonging to the deceased is located at 6.Other information relevant to this petition: Date State Medical Examiner / Deputy Medical Examiner Print or Type Name Telephone Number Fax Number Subscribed and sworn to or affirmed before me at , Alaska, on . (date) (SEAL) Clerk of Court, Notary Public, or other person authorized to administer oaths. My commission expires American LegalNet, Inc. www.FormsWorkFlow.com