AUTHORIZATION FOR CREMATION AND DISPOSITION
NOTICE: THIS IS A LEGAL DOCUMENT. IT CONTAINS IMPORTANT PROVISIONS
CONCERNING CREMATION. CREMATION IS IRREVERSIBLE AND FINAL. READ THIS DOCUMENT CAREFULLY BEFORE SIGNING:
INITIALS *
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CREMATION WILL BE PERFORMED AT A OUR OFF SITE LOCATION. I, THE
UNDERSIGNED, HEREBY AUTHORIZE Alternative Cremation TO PROCEED AS FOLLOWS:
I hereby certify that I am the nearest degree of relationship to the deceased and that I have the legal right or am charged to authorize this cremation, and the disposal of the remains. I understand that due to the nature of the cremation process any valuable metal, including dental gold, will either be destroyed or not be recoverable. Any personal possessions accordingly have either been removed or may be destroyed. I further agree that I will indemnify and hold harmless the Crematory and Funeral Home, their officers and employees from any liability, damage and/or loss of property, costs, expenses or claims resulting from this authorization.
INITIALS *
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I request that following cremation, the funeral home make disposition of the cremated remains as follows: *
I specifically agree that if the said cremated remains are left in the custody of ACS
for over 90 days, ACS may make whatever disposition of the cremated remains it
deems appropriate.
INITIALS *
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DESCRIPTION OF IMPLANTED DEVICE:
Pacemaker *
 
I have Initialed all 3 spaces above, I have answered Yes or No to having a Pacemaker as asked above
and have Completed all questions below Truthfully and under Perjury of Law.
Responsible Party SIGNATURE *
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