AOC-859 Rev. 1-15 Page 1 of 1 Doc. Code: PPC Case No. ____________________ Court PETITION TO PREVENT CREMATION OF DECEDENT County Division ____________________ District Civil ____________________ ____________________ Commonwealth of Kentucky Court of Justice www.courts.ky.gov IN RE: ___________________________________________________________________ Name of Decedent (please print) Date of Death: __________________________________, 2________ Comes_______________________________________________________________________________________, the [ [ ] surviving spouse of decedent [ ] surviving adult child [ ] surviving parent [ ] surviving adult grandchildren ] surviving adult sibling [ ] next closest adult relative, and requests the Court find that extraordinary circumstances exist to prevent the crematory from performing the cremation of the decedent named above. _____________________________, 2_______ Date ____________________________________________ Signature of Petitioner Petitioner's Name: ___________________________________________________________________________________ Address: __________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ () Telephone Number: _______________________________ ORDER IN RE: ______________________________________________________________________ Decedent's full name (please print) Petitioner: ___________________________________________________________________ IT IS HEREBY ORDERED that the Petitioners request to prevent the cremation of the above-named decedent is [ ] granted [ ] denied. SO ORDERED THIS _______ day of ___________________________________, 2_______. ___________________________________________ Judge Distribution: Petitioner Crematory File American LegalNet, Inc. www.FormsWorkFlow.com