Coroners Act 1997—Form 1
(see s 16)
Coroners certificate
Full name of deceased:
Usual place of residence of deceased:
I certify that the death of the deceased was reported to me on the		day of		20    .
I am satisfied that there is no reason why the body of the deceased should not be buried, cremated or taken out of the Territory for burial or cremation.

Dated                    20    .
Coroner