Date:

to release the Remains and Personal Effects of
to Lyles Funeral Service of Purcellville, Virginia.
I further authorize Lyles Funeral Service of Purcellville, Virginia to prepare the remains of scientifically for a Christian Burial.
and oblige.
1. “Except in certain special cases, embalming is not required by law. Embalming may be necessary, however, if you select certain funeral arrangements, such as a funeral with a viewing.”
"If you do not want embalming you usually have the right to choose an arrangement which does not require you to pay for it, such as direct cremation or immediate burial.”
LYLES FUNERAL SERVICE
630 SOUTH 20TH STREET
P.O. BOX 397
PURCELLVILE, VIRGINIA 20134-0397
(540) 338-3834 OR 1-800-388-1913
Authorize for Embalming by Telephone From: 
lyles.2.doc

Relationship

am/pm

Time

Date

Relationship

Witness

Witness

I hereby authorize: