Los Angeles local probate form — Ex Parte Petition for Court Order to Release Remains of a Decedent (LASC PRO 017)

Source: https://lascpubstorage.blob.core.windows.net/forms/Forms%20Comprehensive%20List/LASC%20PRO%20017.pdf

NAME AND ADDRESS OF ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE BAR NUMBER FOR COURT USE ONLY

TELEPHONE NO.:

E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES COURTHOUSE ADDRESS:

CASE NAME:

CASE NUMBER:
EX PARTE PETITION FOR COURT ORDER TO RELEASE REMAINS OF A HEARING DATE:
DECEDENT
DEPT: TIME:

THIS EX PARTE PETITION IS ONLY TO REQUEST RELEASE OF THE REMAINS OF THE DECEDENT AND DOES NOT CONTAIN ANY REQUEST TO ADMINISTER THE ESTATE OF DECEDENT.

1.Petitioner, _____________________________________, requests an order from the Court authorizing him/her (Your Name) to claim the remains of the decedent _______________________________ for purposes of final disposition. (Decedent’s Name) 2.Decedent died on: _______________________ at: ___________________________________. (Date) (City and State) Check one: Decedent was a resident of the County of Los Angeles and his/her remains are in the custody of the Los Angeles County Coroner or a hospital or mortuary located in Los Angeles County. Decedent was NOT a resident of the County of Los Angeles and his/her remains are in the custody of the Los Angeles County Coroner or a hospital or mortuary located in Los Angeles County. 3. Street address, city, and county of decedent’s residence at time of death (specify):

4. Did the decedent leave any written burial instructions? Yes No Unknown
   If yes, please attach a copy of the written instructions. If instructions are in a Will that the decedent made, please
   provide a copy of the Will.

5. DidAdvancethe decedentHealth CarecompleteDirective)a Powernamingof Attorneyan agent?for HealthYesCare (oftenNonominatedUnknownin a document called an If yes, please list the name and contact information of the agent (or write “self” if you are the named agent) and attach a copy of the completed document.

SCLAC PRO 017 Rev. 04/26 For Mandatory Use Health & Safety Code § 7100, 7105

Case Name: Case Number:

6. My relationship to the decedent is: __________________________________. [If you are not related to the decedent by either blood or marriage, describe below how long you have known the decedent and how you met (work, church, neighbor, etc.)]:

7. To the best of my knowledge, Decedent is survived by (check all that apply):
   a. Spouse f. Brothers or Sisters
   b. Registered Domestic Partner g. Grandparents
   c. Child(ren), Natural or Adopted h. Aunts or Uncles
   d. Grandchild(ren) i. Cousins
   e. Parent or Parents j. No Next of Kin (if this box is checked, skip to
   question 12 below).

8. Listed below are all of the decedent’s known relatives, their relationship(s) to the decedent, approximate age(s), address(es) and phone number(s):

9. Have the relatives nominated you to make burial arrangements? Yes No
   If yes, please attach the nomination(s).

10. Are there any disagreements amongst the persons named in Paragraph 7 as to the location, manner and conditions of disposition of the remains of the decedent? Yes No

11. I have made the following attempts to contact decedent’s relatives to inform them of my request to claim th

    e decedent’sremains (describe below or attach declaration):

12. Decedent has no known living relatives. I know this because (describe below, for example, “The decedent tol

d many times that he had no relatives,” or “I have known the decedent for 10 years and she never spoke of
having any family.”):
EX PARTE PETITION FOR ORDER TO RELEASE REMAINS

SCLAC PRO 017 Rev. 04/26 For Mandatory Use Health & Safety Code § 7100, 7105

Case Name: Case Number:

13. If I am a non-relative of the decedent, telephonic notice has been provided to the Public Administrator.

14. I (the petitioner) take full responsibility for all costs involved in connection with the final disposition of
    decedent's remains.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date: SIGN Petitioner’s Signature

Type or Print Petitioner’s Name

EX PARTE PETITION FOR ORDER TO RELEASE REMAINS

SCLAC PRO 017 Rev. 04/26 For Mandatory Use Health & Safety Code § 7100, 7105