Dos-1898-F-L - Authorization For Cremation And Disposition Page 2
Download a blank fillable Dos-1898-F-L - Authorization For Cremation And Disposition in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Dos-1898-F-L - Authorization For Cremation And Disposition with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3I am/ we are the person(s) having priority under Public Health Law section 4201 and have the right to authorize
cremation of the remains of the deceased. My/Our relationship to the deceased is as follows:
(Insert from the list below)
Number:
Description:
1. A person designated in writing pursuant to Public Health Law section 4201(3);
2. The surviving spouse;
2a. The surviving domestic partner;
3. Any surviving child eighteen years of age or older;
4. A surviving parent;
5. A surviving sibling eighteen years of age or older;
6. A lawfully appointed guardian;
7. Any person(s) eighteen years of age or older entitled to share in the estate and who is/are closest in
relationship to the deceased;
8. A duly appointed fiduciary of the estate;
9. A close friend or relative who has executed a written statement pursuant to Public Health Law §4201(7);
10. A chief fiscal officer of a county or a public administrator appointed pursuant to the Surrogate's Court
Procedure Act;
10a. Any other person who is acting on behalf of the deceased and who has executed a written statement
pursuant to Public Health Law §4201(7).
(Initial ALL THREE of the following)
_______ I/We hereby affirm that the body of the deceased does not contain a battery, battery pack, power cell,
radioactive implant, or radioactive device and that any such materials were removed prior to the execution of this
Authorization Form. Failure to remove these items prior to cremation may result in harm to the crematory and
crematory personnel.
_______ I/We hereby affirm that instructions have been given to
___________________________
(funeral director name)
regarding the removal of any personal property or other thing of value which any person signing below or any family
member of the deceased wishes to preserve.
_______________________________________ is not
(crematory name)
responsible for removal of personal items from the container or from the remains of the deceased. Personal items
left in the container or with the remains will be destroyed by the cremation process and cannot be retrieved
after cremation.
_________________________________________ to cremate the
_______ I/We hereby authorize
(crematory name)
remains of the deceased.
FINAL DISPOSITION
The person authorized to receive the cremated remains of the deceased from the crematory is:
Name:
Address:
Phone:
The cremated remains of deceased will be disposed of as follows:
If for any reason the person named above does not take possession of the cremated remains,
________________________________________ is authorized to give possession of the remains to
(crematory name)
_________________________________________ by delivery in person or by registered mail.
(funeral home name)
DOS-1898-f-l (Rev. 01/10)
Page 2 of 3
Name of Deceased
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business