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
BODY IDENTIFICATION RECORD
Case Number:_____________________________
Date:____________________________________
Name of Decedent:__________________________________________
I,___________________________________________________,
hereby acknowledge that I have viewed
(Select One) photograph OR the body
of a deceased person believed to be:_________________________________________________
The photograph or body that I viewed is that of the above-named decedent. I am related to the named decedent as:
Family (specify):________________________________________________________
Friend (specify:_________________________________________________________
Acquaintance (specify length of time known):_____________________________
Signed___________________________________________________________________
Date ____________________________________
Address:_________________________________________________________________
Telephone Number (include area code):____________________________________
Witness _________________________________________________________________
SCIENTIFIC AND SECONDARY IDENTIFICATION
(Indicate method[s] used and name of analyst)
Fingerprint Comparison:_________________
Fingerprint Analyst:_____________________________________________________
Dental Comparison: _____________________
Dental Analyst:__________________________________________________________
Hospital ID: ___________________________
Name of County ME:_______________________________________________________
Personal Effects (specify):______________________________________________
Law Enforcement Agency: ___________________
Name of Officer:_________________________________________________________
Circumstances (specify___________________________________________________
_________________________________________________________________________
Form ME-8 (11/05)
