Authorization for Cremation and Disposition

Deceased / Beneficiary Name

Gender
MaleFemale

Date of Death

Time of Death

County of Death

I/We the undersigned, certify, warrant and represent that I/We have the full legal right and authority to authorize the cremation, processing and disposition of the remains of the above named Deceased/Beneficiary.

I/We hereby request and authorize ICS Cremation and Funeral Home (herein referred to as the "Funeral Establishment" to take possession of and make arrangements for the cremation of the remains of the Deceased/Beneficiary at: ICS Crematory.

Disposition of Cremated Remains

I/We authorize the Crematory to return the cremated remains of the Deceased/Beneficiary to the possession and custody of the Funeral Establishment. I/We understand that the services and obligations of the Crematory shall be fulfilled when the remains of the Deceased/Beneficiary are returned to the possession and custody of the Funeral Establishment.

I/We hereby authorize the disposition/release/delivery/or shipment of the cremated remains of the Deceased/Beneficiary as follows:

Release to family:

Name and Relationship of the family member:

Deliver to:

Enter instructions on who to deliver to:

Ship via USPS to:

Enter the address where the remains will be shipped to. All cremated remains are shipped Registered Mail via USPS. Our shipping charge is $50.00 anywhere in the U.S.

Special Handling/Other

Please enter special instructions below:

The cremation, processing and disposition of the remains of the Deceased/Beneficiary authorized herein shall be performed in accordance with all governing laws, regulations and policies of the Crematory and Funeral Establishment, and the following terms and conditions:

1. The remains of the Deceased/Beneficiary will not be accepted for cremation unless received by the Crematory in a combustible, leak resistant, rigid cremation container. The Crematory is authorized to remove and dispose of handles, ornaments and any other noncombustible items attached to the cremation container prior to cremation. In the event the remains of the Deceased/Beneficiary are received by the Crematory in a casket or other container constructed noncombustible or combustible or hazardous materials, I/We authorize the remains of the Deceased/Beneficiary to be removed prior to cremation and placed in a combustible cremation container. I/We further authorize the Funeral Establishment or Crematory to make disposition of any such noncombustible casket in any lawful manner it deems appropriate.

2. Mechanical or radioactive devices implanted in the remains of the Deceased/Beneficiary (such as pacemakers, etc.) may create a hazard when placed in the cremation chamber. The Crematory will not cremate any human remains which contain any type of implanted mechanical or radioactive device. In the event the remains of the Deceased/Beneficiary contain such a device, I/We hereby authorize the Funeral Establishment, its agents and employees, to remove any such mechanical devices for the remains of the Deceased/Beneficiary prior to cremation, and dispose of such items at its discretion unless otherwise directed.

Does the Deceased/Beneficiary have any such mechanical implants or devices
YesNo

3. I/We agree that if permanent arrangements for final disposition of the cremated remains are to be carried out by the authorize representative(s) or their duly authorized agent, and such arrangements have not been completed within 120 days after the date of availability of such cremated remains for final disposition, the Funeral Establishment is authorized and directed to dispose of the cremated remains in any dignified manner suitable.

4. I/We agree to indemnify, release and hold the Crematory, Funeral Establishment, their affiliates, agents, employees, and assigns, harmless from any and all loss, damages, liability, or causes of action (including attorney's fees and expenses of litigation) in connection with the cremation and disposition of the cremated remains of the Deceased/Beneficiary, as authorized herein, or my/our failure to correctly identify the remains of the Deceased/Beneficiary, disclose the presence of any implanted mechanical or radioactive devices, or take possession of, or make permanent arrangements for, the disposition of such remains.

5. Except as set forth in this Authorization, no warranties expressed, or implied, are made by the Funeral Establishment, Crematory or any of their respective affiliates, agents or employees.

Electronic Signature of Person(s) Authorizing Cremation and Disposition:

Relationship to Deceased/Beneficiary

DISCLAIMER:

BY SUBMITTING THIS FORM, I/WE AGREE THAT WE ARE THE ABOVE MENTIONED PERSON(S) AND ARE RELATED TO THE DECEASED/BENEFICIARY AS STATED ABOVE. THIS IS A LEGAL DOCUMENT AND ANY FRAUDULENT ACTIVITY IN THIS FORM MAY BE PROSECUTED TO THE FULLEST EXTENT OF THE LAW.