Fillable Cremation Authorization Form printable pdf download

CREMATION AUTHORIZATION

The undersigned authorizing agent(s) hereby attest to the accuracy of the representations contained herein and represent

and certify the identity of the remains of the deceased ___________________________________________who passed

away at ________ __.M. on ___________________________________. I/we hereby certify that I/we have the legal

rights to authorize the cremation, handling, processing and disposition of the deceased’s remains and that I/we are not

aware of any living person who has superior right to serve as an authorizing agent. If there is another person who has

superior right, all reasonable efforts have been made without success to locate them and that the undersigned has no

reason to believe such person would object to cremation.

The undersigned authorizes ___________________________________________ (Funeral Home) to assume possession

of the remains of the deceased and further authorizes said Funeral Home to handle, possess and arrange for cremation at

MORGAN CREMATION SERVICES and disposition of such remains. Authorization is further given to the above

crematory to cremate said remains.

The undersigned have/have not made arrangements for viewing or service to be conducted prior to the cremation and if

so, such date of viewing or service is on ________________________________________ to be followed by cremation.

In the case of no viewing or service, cremation shall take place upon receipt of the remains by the crematory.

The following items of value, if any shall be placed with the deceased’s remains and shall be disposed of as follows:

_________________________________________________________________________________________

The final disposition of the cremated remains shall be:

( ) Release to ( ) Ship to ( ) Other __________________________________________________________________

It is understood that unless arrangements have been made for the final disposition of the cremated remains, the

Crematory may after 30 days, return the cremated remains to the authorizing agent, or if not possible, may after 60 days,

at the expense of the authorizing agent, dispose of the cremated remains in a manner permitted by law.

The undersigned represents that the death of the decedent did/did not occur as a result of disease declared by the Illinois

Department of Public Health to be infectious, contagious, communicable or dangerous to public health. Type of disease

if any:

___________________________________________________________________________________________

It is understood that cremation can not take place if a pacemaker or other material or implant is present in the deceased

an it is hereby represented that such device or material exists they are described as

follows:___________________________________________________________________________________ and the

Funeral Home is hereby authorized to remove and dispose of such devices or materials prior to cremation._____ (initial)

Because of the possibility of damage to the retort the Crematory reserves the right to remove and destroy all handles,

gloss furnishings, casket lids or any other items on the outside of caskets used for cremation.

The undersigned hereby indemnify and release the Crematory, Funeral Home and their employees and agents from any

and all mis-identity of the deceased and the presence of pacemakers or other materials or implants.

The Funeral Home warrants that the human remains released to the Crematory are the same as those identified

herein.

Signature of Authorizing Agent

Print Name

Relationship

Date

Address

Telephone Number

Signature of Authorizing Agent

Print Name

Relationship

Date

Address

Telephone Number

Signature of Funeral Home Representative

Print Name

License Number

Name, Address and Telephone Number of Funeral Home

NOTARY:

Subscribed and sworn before me this _______________day of _________________________, 20________.

_________________________________________My Commission Expires __________________________

Cremation Authorization Form

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