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Get PA PA 118 2016-2024

IENT NO. REQUEST FOR BURIAL AND/OR CREMATION PAYMENT: RELATIONSHIP TO DECEASED: I request the Department of Human Services to pay the burial and/or cremation expenses of: I am a Representative of a fraternal society (deceased was a member) or of a charitable or religious organization: RELATIVE TO BE FILLED IN BY PERSON MAKING REQUEST State Relationship (Give Name of Organization) FRIEND If this block is checked, this form must be accompanied by an unfit certificate from the Anatom.

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