Sample Cremation Authorization Form (Page 2 of 2) in pdf

completed; (b) at least 48 hours have transpired since the death occurred (no waiting period is required in the case of death

resulting from a contagious or infectious disease and ***Funeral Home*** reserves the rights to perform the cremation

thereafter according to its own schedule); (c) the burial permit has been received along with a copy of the signed death

certificate and cremation authorization form; (d) the decedent has been viewed by a State appointed medical examiner or

assistant examiner and the medical examiner certificate has been signed (e) the deceased had been wrapped in a leak proof

pouch and placed in the cremation container, as selected; and (f) no objections concerning the cremation have been raised.

Cremation is performed by placing the deceased a cremation container and then placing the container into a cremation

chamber or retort, where they are subject to intense heat and flame. Through the use of natural gas, incineration of the

container and its contents is accomplished and all substances are consumed or driven off, except bone fragments (calcium

compounds) and metal (including dental gold and silver and other non human materials) as the temperature is not

sufficient to consume them. ***Funeral Home*** at its sole discretion, reserves the right to remove all noncombustible

materials before cremation and discard them in a non-recoverable manner. Due to the nature of the cremation process any

personal possessions or valuable materials, such as dental gold or jewelry (as well as body prosthesis or dental

bridgework), that are left with the deceased and are not removed from the container prior to cremation will be destroyed

or if not destroyed, will be disposed of. Following a cooling period, the cremated remains, which will normally weigh

several pounds in the case of an average size adult, are swept or raked from the retort. ***Funeral Home*** makes every

reasonable effort to remove all of the cremated remains from the retort, but it is impossible to remove all of them, as some

dust and other residue from the process is always left behind. In addition, while every effort is made to avoid

commingling, inadvertent or incidental commingling of minute particles of cremated remains from the residue of previous

cremations is possible. After the cremated remains are taken from the retort, all noncombustible materials (insofar as

possible) are separated and removed from the human bone fragments by visible or magnetic selection and are disposed of

in a non-recoverable manner. When the cremated remains are remove from the retort and after they have been separated

from other material, they are then mechanically processed (pulverized). This process of crushing or grinding may cause

incidental commingling of the remains with residue coming from the processing of previously cremated remains. These

granulated particles will be virtually unrecognizable as human remains.

SIGNATURE OF AUTHORIZING AGENT

I, _____________________________the undersigned, as Authorizing Agent, hereby certify that I have charge of the

remains of the decedent and as such possess full legal authority and power, according to the laws of New Hampshire, to

execute this authorization for and to arrange for the cremation and disposition of the cremated remains of the decedent. In

addition, I am aware of no objection to this cremation by any spouse, child, parent or sibling of the decedent. Executed at

______________, New Hampshire, this _____ day of ______________, 201__. I authorize the following person(s) or

organization to pick up or accept the cremated remains_________________________________. I request the final

disposition of the cremated remains to be as follows: Buried/Interred in a cemetery ... Kept by Family ... Scattered ...

Other ...

Signature of Authorizing Agent ____________________________________

Relationship_________________ Telephone #______________________

Address____________________________________________________________

Signature of Funeral Director as Witness for Signature of Authorizing

Agent____________________________________________________________

Sourced from Cremation Authorization form by Phaneuf Funeral Homes and Crematorium, Manchester, NH

Sample Cremation Authorization Form Page 2