ME-2 Embalming (computer ready form)

Date: 
05/05/2015
Document Text Version

Iowa Office of the State Medical Examiner
Department of Public Health
2250 South Ankeny Blvd.
Ankeny, IA 50023-9093
Phone: 515-725-1400
FAX: 515-725-1414

MEDICAL EXAMINER EMBALMING CERTIFICATE

County of __________________________________

Under the provisions of Chapter 331, of the Code of Iowa, I hereby certify that on

(date)_____________________,
I viewed the body and made an investigation of the death of

(Name of Decedent)_________________________________

(Age)__________________

(Sex)__________________

who died on (date)_____________________ at

(Street & No. or Rural Route)______________________________________

(City & State)___________________________________

(County)_______________________________________

and herewith give my permission to

(Embalmer)_____________________________________

(City & State)_________________________________

to embalm the body of the above-named decedent.

Name of Medical Examiner___________________________________________

Signature of Medical Examiner______________________________________

City & State____________________________________

County________________________________________

Date__________________________________________

Note: This certificate must be accompanied by permission of the family, or evidence that a diligent search was made to find the family, prior to embalming.

One copy each to the embalmer and county medical examiner.

Form ME-2 (11/05)

Printed from the Iowa Office of the State Medical Examiner website on October 29, 2020 at 8:40pm.