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Get ICCFA PERS EFFCTS 2012-2024

Al Home Dispose Bury OR Place with *Return Cremate with Cremated to Deceased Remains Family Authorization for Disposition The above listed personal belongings were received and shall be disposed of as indicated above; the disposition is authorized by: __________________________ _______________________________ __________ ________ (Name of Authorizing Agent) (Signature of Authorizing Agent) (Relationship) (Date) * If Disposition is listed as “Return to Family”, the following individual(s) ma.

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