AB Number

Cadaver #

Police Complaint #

OCME Case #

Month/Year

Body Site Location: SAB - BALTIMORE || STATE ANATOMY BOARD BODY DATA PACKET

Program

C.A.I.

Ashes:

Requested

Picked Up

Mailed

Date Sent:
Request Number:

Database ID:

Date of Death:

Date Cremated:

Yr Ashes Buried:

Place of Death/Transported

OCME

Death Certificate Filed:

Sent: Acknowledgement Letter
Sent: Ashes Letter
Sent: Yes/No Letter
Sent: Final Notice

Information For Claim

Date Claimed:
Journal Date:

Transport

Transportation to SAB
Arterial Flush ($112)
Anatomical Prep ($345)
UC Storage Fee ($25/day)
Pouch
Cremation Box ($33)
Cremation
Postage ($22)
Total Charges

Charge

CLAIMED BY:

Date:

Time:

Funeral Establishment:

Name:

Address:

City:

State:

Zip Code:

Phone:

ASHES REQUESTED BY: