Toggle navigation
Office of the Chief Medical Examiner
Application for Cremation, Anatomical Donation or Burial at Sea Approval (
*
= Mandatory field
)
Request Type:
Cremation Approval $75.00
Anatomical Donation $0.00
Burial at Sea $75.00
!
Decedent Info:
Decedent First Name:
!
Decedent Last Name:
!
Decedent SSN:
!
Decedent Sex:
M
F
!
Date/Time of Death:
!
Invalid Date/Time
Date of Birth:
Invalid Date
Place of Death (facility name, or if not institution, give street address, city and zip code):
!
OCME Case Number (
if applicable
):
Requesting Institution Type:
hospital
funeral home
!
Requesting Institution Name:
!
Contact Info:
Contact First Name:
!
Contact Last Name:
!
Contact Phone:
!
Contact Email:
!
Invalid Format
Comments:
Payment Information:
Credit Card Type:
Visa
MasterCard
Discover
American Express
!
Credit Card Number:
!
Credit Card Expiration Date:
01
02
03
04
05
06
07
08
09
10
11
12
/
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
!
Cardholder Name:
!
Cardholder Address:
!
Continue
Reset
*** Please address validation errors on the page ***