Confirmation of Identification Without Viewing

PART I.

To be completed by a funeral home representative whenever there is no visual identification:

Decedent's Name

Reason Visual Identification Not Performed

Describe Alternative Methods Used to Confirm Identification (e.g. photographs, scars, tattoos)

Names of Individual Providing Information

Name of Funeral Home Representative Confirming Identification

Signature of Funeral Home Representative

PART II.

To be completed by next-of-kin or other legally authorized person making arrangements: I,

having declined to make identification through actual viewing of the remains of

Hereby agree to indemnify and hold F.B. Pratt & Son, Inc., and its officers, directors, shareholders, affiliates, agents, employees, successors and assigns harmless from any and all claims, liabilities, damages, losses, suits or causes of action (including attorneys' fees and expenses of litigation) brought by any person, firm, or corporation of the personal representative thereof, relating to or arising out of such failure to identify.

Signature

Date

Print Name of Next-of-Kin

Witnessed By

Date

Time