Authorization For Cremation And Disposition Of Human Remains Page 2

ADVERTISEMENT

FINAL DISPOSITION
After cremation, the Crematory will arrange for the disposition of the cremated remains as follows, and the Authorizing
Agent(s) hereby authorizes the Crematory to release, deliver, transport, or ship the cremated remains as specified. Initial
one of the following:
1. ______ Deliver the cremated remains to ______________________________________ Cemetery, where
arrangements have already been made for the cremated remains to be: _______________________________________
_______________________________________________________________________________________________
2. ______ Deliver or release the cremated remains to the following designated person:
Name: _______________________________________________ Relationship: _______________________________
Address: ______________________________________________________________________________________
3. ______ Deliver the cremated remains to the Funeral Home.
4. ______ Deliver the cremated remains to the U. S. Postal Service, where they will be mailed by the acceptable method
to: Name: ____________________________________________________________________________________
Address: _______________________________________________________________________________________
5. ______ Other: __________________________________________________________________________________
AUTHORITY OF AUTHORIZING AGENTS
I (We) hereby certify that the Decedent left the following surviving heirs:
Spouse:
Yes_____ No _____ Name: _______________________________________________________________
Children:
Yes_____ No _____ How Many ________ Name(s):___________________________________________
_____________________________________________________________________________________
Parents:
Yes_____ No _____ How Many ________ Name(s):___________________________________________
_____________________________________________________________________________________
Siblings:
Yes_____ No _____ How Many ________ Name(s):__________________________________________
__________________________________________________________________________________
Other:
Names and Relationship: _______________________________________________________________
If the legal next of kin or if all persons of the same degree of kinship are not signing below, a written explanation must
be completed by the person(s) signing below as Authorizing Agent(s). If the Authorizing Agent has a valid Durable Power
of Attorney for Healthcare in accordance with Tenn. Code Ann. Sections 62-5-703 and 34-6-204, please attach a copy to
this form.
Initial: _______I (We) hereby certify that I am the closest living next of kin of the Decedent, or that I otherwise serve in
the capacity of _______________________________________ to the Decedent, that I have charge of the remains of the
Decedent and possess full legal authority and power to execute the authorization for and to arrange for the cremation
and disposition of the cremated remains of the Decedent. I am aware of no objection to this cremation by any spouse,
child, parent, or sibling specified.
Page 2 of 3

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 3