Cremation Authorization Form

THE CREMATION PROCESS IS PERFORMED ACCORDING TO CALIFORNIA LAW. THERE CAN BE NO ALLOWANCE FOR ETHNIC OR RELIGIOUS VARIATION.

Subject to the rules and regulations of East Lawn Inc. and any applicable federal, state or local law or ordinances, the undersigned hereby certifies, warrants and represents that I/we have the full legal right and authority to authorize and do hereby authorize East Lawn Inc. (hereafter the "Crematory'') to perform the cremation of the remains of:

and to arrange final disposition of the cremated remains as follows:

By signing this Authorization for Cremation and Disposition, I/we acknowledge and agree that I/we have read and understood every part of this authorization, including the fact that the process of cremation is irreversible, and that I/we nevertheless desire that the Deceased's remains be cremated in accordance with this authorization. This agreement supersedes any prior oral, written, or implied agreements related to the services provided herein and its terms can only subsequently be changed by a writing signed by the licensee and the statutory right holder.

MERCHANDISE TO BE USED: East Lawn requires either a casket or alternative (cremation) container. All caskets and alternative containers must meet the following standards: 1) be composed of combustible materials suitable for cremation; 2) be able to be closed to provide a complete covering for human remains; 3) be resistant to leakage or spillage; 4) be sufficient for handling with ease; and 5) be able to provide protection for health and safety of Crematory personnel.

METAL, PLASTIC OR FIBERGLASS CASKETS OR CREMATION CONTAINERS WILL NOT BE ALLOWED TO BE CREMATED.

The Crematory is authorized to remove and dispose of handles, ornaments, and any other non-combustible items attached to the cremation container prior to cremation. I/We further authorize the Crematory to make disposition of any non-combustible items in any lawful manner it deems appropriate. These may include, but are not limited to, hinges, handles, latches, nails, staples, etc. The crematory will not inspect remains prior to cremation and will not open the cremation container.

PACEMAKERS, PROSTHESES, AND RADIOACTIVE DEVICES:
Pacemakers and prostheses, as well as any mechanical or radioactive devices or implants in the Decedent, may create a hazardous condition when placed in the cremation chamber. It is imperative that such items be removed prior to cremation. If East Lawn is not notified of these devices and implants, and not instructed to remove them, then the person(s) authorizing the cremation will be held responsible for any damages caused to East Lawn personnel or equipment by such devices or implants. By initialing this paragraph, I/we give my permission for the funeral director or other funeral home employee to remove the surgical hardware as referenced above prior to cremation. The mortuary and/or Crematory are authorized to dispose of the same as they deem appropriate.
*(initials) Yes, please remove None

THE CREMATION PROCESS:
The human body burns with the casket, container, or other material in the cremation chamber. Some bone fragments are not combustible at the incineration temperature and, as a result, remain in the cremation chamber. During the cremation, the contents of the chamber may be moved to facilitate incineration. The chamber is composed of ceramic or other material which disintegrates slightly during each cremation and the product of that disintegration is commingled with the cremated remains. Nearly all of the contents of the cremation chamber, consisting of the cremated remains, disintegrated chamber material, and small amounts of residue from previous cremations, are removed together and crushed, pulverized, or ground to facilitate inurnment or scattering. Some residue remains in the cracks and uneven places of the chamber. Periodically, the accumulation of this residue is removed and interred in the cemetery.
*(initials)

The cremated remains shall be processed so that they are suitable for inurnment within a cremated remains container or an urn. If the cremated remains container or designated urn cannot accommodate all cremated remains of the deceased, the crematory shall provide a larger cremated remains container at no additional cost, or place the excess in a second container that cannot easily come apart from the first, pursuant to Section 8345 of the Health and Safety Code. In the event that all cremated remains will not fit into the cremated remains container or designated urn, I/we direct East Lawn to * (initial one):

ADDITIONAL DETAILS AND INFORMATION ABOUT CREMATION ARE IN THE INFORMATION BOOKLET ''CREMATION FACTS''. I/We have received the booklet entitled " Cremation Facts''. (initials)  

I/We warrant that all representations and statements made herein are true and correct.

I/We am/are an agent under a Durable Power of Attorney for Health Care, or in the absence thereof, the legal next of kin to the Decedent and as such possess full legal authority and power, according to Section 7100 of the California Health and Safety code, to execute this authorization form and to arrange for the cremation and disposition of the cremated remains of the Decedent.

REMOVAL RIGHTS: A person having the right to control disposition of cremated remains may remove the remains in a durable container from the place of cremation or interment, pursuant to Section 7054.6 of the Health and Safety Code.

I/We authorize East Lawn Inc. to: make a reasonable effort to recover all metal from the cremation chamber with the remains; to discard metal used in construction of the casket or alternative container, prostheses and all other metal; and to place back with the cremated remains any metal belonging to the Deceased including identifiable bridgework, tooth filling, and any jewelry or mementos which may not have been removed prior to cremation.

CREMATED REMAINS LEFT LONGER THAN ONE(l) YEAR WITHOUT BEING RETRIEVED BY A FAMILY MEMBER OR ABOVE STATED RESPONSIBLE PARTY SHALL BE DISPOSED OF BY INTERMENT WITH THE RESPONSIBLE PARTY(IES) BEING RESPONSIBLE FOR INTERMENT, DISINTERMENT, AND/OR HOLDING FEES. If the cremated remains are not retrieved by the family within 180 days from the date of this form, the responsible party will be notified by certified mail at the address listed below. If the cremated remains are not retrieved within the next 180 days from the date of the certified letter, the mortuary is authorized and directed to inter the cremated remains in any lawful manner it deems appropriate.

IT IS UNDERSTOOD THAT IN THE EVENT CREMATED REMAINS ARE TO BE MAILED, THEY WILL BE SENT VIA THE UNITED STATES POSTAL SERVICE CERTIFIED, RETURN RECEIPT REQUESTED MAIL ONLY.

EAST LAWN CREMATORY HAS A CHARGE OF $450.00 FOR THE ACTUAL CREMATION PROCESS. THIS CHARGE IS NORMALLY FOUND ON THE CASH ADVANCE SECTION OF THE MORTUARY CONTRACT.

CREMATED REMAINS WILL HAVE A HOLDING FEE OF $100.00 PER MONTH IF HELD LONGER THAN 30 DAYS.

Should I/we fail to correctly identify the remains of the deceased, fail to disclose the presence of any implanted mechanical or radioactive devices, or fail to take possession of, or make permanent arrangements for the disposition of, the cremated remains, I/we agree to indemnify, release and hold East Lawn Inc. the Crematory, funeral home, their affiliates, agents, employees and assigns harmless from any and all losses, damages, liability or causes of action in connection with the cremation and disposition of the cremated remains as authorized herein.

I/We declare under penalty of perjury that the foregoing is true and correct and that I/we make these statements to induce East Lawn Inc. to cremate or cause to be cremated the remains of the Decedent. This is your authority to make disposition of the cremated remains as indicated in this form, and I/we assume full responsibility for the identity of the Decedent whether or not I/We viewed the remains.

IF THERE ARE OTHERS OF EQUAL KINSHIP, THEIR WRITTEN PERMISSION IS REQUIRED ON THE ADDENDUM PART OF THIS AUTHORIZATION.

ADDENDUM

MULTIPLE NEXT OF KIN SIGNATURE SECTION:

The undersigned have the right to authorize the cremation and disposition of the above named decedent. By executing the addendum to the Authorization For Cremation And Disposition Of Human Remains, as authorizing agents, warrants that all representations and statements contained within the Authorization of Cremation Form are true and correct, that these statements were made to ihnduce East Lawn, Inc. to cremate the human remains of the Decedent, and that the undersigned have read and understand the provisions contained within this cremation contract. I/WE HAVE DISCUSSED AND ARE IN FULL AGREEMENT WITH ALL AREAS OF THIS CREMATION CONTRACT INITIALED BY THE PRIMARY SIGNER OF THIS AGREEMENT.

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ARGUABLE RIGHT FOR CREMATION AND DISPOSITION:

Listed below are the names of survivors of the Decedent who arguably may have the right to authorize the cremation of the Decedent.

The undersigned has made a diligent effort to contact this/these person(s), but has been unable to do so. The undersigned has no reason to believe that this/these person(s) would object to the cremation of the Decedent, and the undersigned therefore elects to assume sole responsibility for authorizing the cremation of the above mentioned Decedent.

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PRE-NEED FUNERAL ARRANGEMENT ADDENDUM:

The arrangements for the disposition of my remains I have made and paid for as set forth in this agreement reflect my complete and final wishes. I understand that pursuant to Health and Safety Code Section 7100.1, my written, pre-paid directions for funeral and/or Interment arrangements may not be altered, changed or otherwise amended in any material way except as required by law or as I may hereafter direct in writing signed and dated by me, I do do not (Initial one) authorize any person who might otherwise have the right to control disposition of my remains pursuant to Health and Safety Code 7100 to materially alter, change or otherwise amend any arrangements made by this agreement.