A written authorization to embalm must contain the required information:

1. (1) The date of the authorization;
2. (2) The name of the funeral establishment that will perform the embalming;
3. (3) The name, address, and relationship to the decedent of the person signing the authorization;
4. (4) An acknowledgment of the circumstances where embalming is required by law;
5. (5) A statement certifying that the person signing the authorization is the person with legal right to control the disposition of the body as prescribed in Arkansas Code § 20-17-102 or that person’s legal designee;
6. (6) The name and signature of the person requesting the authorization and that person’s relationship to the funeral establishment where the procedure will be performed; and
7. (7) The signature of the person who has the legal right to control the disposition or his or her legal designee.