Funeral Home Application - Masjid Al-Huda

I, the undersigned, as next of kin to the deceased:
Name First: ___________________________________ MI: _______ Last: ____________________________________
Date of Death: ______/______/_____________________ Date of Birth: ______/______/_______________________
Hereby on behalf of the remaining family members of deceased, do hereby appoint and authorize Milwaukee
Muslim Funeral Home, Inc. to perform following functions:
Transport body of the decedent the Milwaukee Muslim Funeral Home;
Provide refrigerated storage of the body, as needed;
Prepare the body for burial pursuant to standard Islamic procedure at the funeral home in preparation for
Transport of the body to a cemetery designated by the family in Greater Milwaukee Area.
The body will be buried in a minimum required (by the cemetery) card board casket.
I will contact ISM to get approval for lot at respective cemetery & contact the cemetery for the burial
The funeral home does not provide out of state or country transportation of the body.
The undersigned will be solely responsible in case of any dispute or legal proceedings initiated by third party or
other family member regarding the standard procedure followed by the Milwaukee Muslim Funeral Home and its
staff members during funeral and burial arrangements. The undersigned acknowledges and agrees that the body
will be prepared for burial according to standard Islamic procedure and that unless agreed to separately, no
embalming will occur.
Signature: _________________________________
Date: __________________________
Name First: ____________________________________ MI _______ Last: ___________________________________
Relation to decedent: _______________________________________________________________________________
Phone: _____/_____/_____________ Email: ___________________________________________________________
Address: __________________________________________________________________________________________