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2. The Shelby County Coroner's Office issues authorization to cremate electronically due to the efficiency for maintaining lasting digital records, statistics, ease of access and short wait times, compared to other means.
4. Authorizations are only for deaths which occurred inside Shelby County, AL and or the injury that occurred leading to death also occurred in Shelby County, AL.
6. Complete our electronic form on this page and submit. Pay careful attention that you enter your email correctly because this is an automated process and we will email confirmation exactly to the address as entered. Make sure we don't end up in your spam folder!
8. Remember that this does not waive the 24 hour wait period before cremation can occur, from the time of death or any other Alabama legal requirements.
10. All submissions are delivered to the coroner's office email to ensure real time review when you submit. This allows for fast processing to ensure there was a coroner/ME/or physician to certify the death and there is no known suspicion to halt cremation at this time for said person, in accordance under Alabama law.
14. This request for cremation shall only be made to the Coroner of the county where the sequence of events began that ultimately resulted in the death.
16. Date*
    Date
17. To the Coroner of Shelby County REQUEST TO CREMATE THE BODY OF:
19. Full Name*
20. Age*
22. Race*
23. Sex*
24. Date of Birth*
    Date of Birth
25. SSN
29. Date of Death*
    Date of Death
30. Time of Death
    Time of Death
31. Place of Death (facility name/address)
33. Address
34. City
36. State
37. Zip
41. Authorizing Agent*
42. Relationship*
44. Address*
45. City*
47. State*
48. Zip
49. Phone*
50. Phone 2
54. Person Certifying Death*
55. Phone*
57. Medical Facility / Practice Name*
58. Address*
60. City*
61. State*
62. Zip
64. Circumstances Surrounding Death (e.g. disease, injury/trauma, motor vehicle collision, suspected overdose, etc.)*
66. Manner of Death: (Natural, Accident, Homicide, Suicide, Unknown)*
68. Cause of Death*
70. Type*

    1. HOSPICE DEATH

    1. INPATIENT DEATH

    1. HOME DEATH

    1. CORONER CASE
74. Mortuary*
75. Address*
77. City*
78. State*
79. Zip
80. Phone*
82. Coroner authorizing cremation (name)*
83. Date*
    Date
84. Time
    Time
88. Pursuant to Code of Alabama 22-9A-16, I certify that the information contained herein is true and accurate.
90. Funeral Director*
91. Sign
92. Date*
    Date
94. Authorizing Agent*
95. Sign
96. Date*
    Date
98. Both the funeral director and authorizing agent are required.
100. Email Address*
Leave This Blank:


102. 1. Receive an email copy of this form.
103. Email address

     This field is not part of the form submission.

104. Submit

* indicates a required field