Authorization for Cremation and Disposition

Authorization for Cremation and Disposition

  • This Authorization Form must be completed and signed prior to delivery of remains for cremation.

  • Date Format: MM slash DD slash YYYY

  • Cremation is carried out by placing the remains of the deceased and the container holding the remains into a cremation chamber where they are subjected to intense heat and flame. The heat and flame will incinerate and consume everything except bone and metal, which are all that will be left after cremation.
    Following cremation, the crematory will take reasonable efforts to remove all of the remains and other material from the cremation chamber, but some minimal dust and residue will likely be left behind. The crematory will separate incidental and foreign material from the remains and the incidental and foreign material will be disposed of as required by law. The cremated remains will be mechanically pulverized into small pieces and placed into a designated container or urn. Cremated remains generally are pulverized until no single fragment is recognizable as skeletal tissue.

  • The crematory may only open the container holding the un-cremated human remains in limited circumstances, such as to confirm the identity of the deceased or to ensure that no material is enclosed which might injure employees or damage the crematory property. If human remains are delivered in a container which is not suitable for cremation such as ceremonial or rental casket, the crematory will require that the remains be moved into a suitable container before it accepts the remains. The opening of a container or the transfer or removal of remains will be conducted before a witness and will be done in privacy, with dignity and respect.

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • (in pounds)

    (Person(s) in control of disposition, initial ONE of the following)
  • I am/We are the designated agent of the deceased designated in a will or written instrument executed pursuant to Public Health Law Section 4201.
  • OR
  • I/We have no knowledge that the deceased executed a written instrument pursuant to Public Health Law Section 4201 or a will containing directions for the disposition of his or her remains and I/we are the person(s) having priority under Public Health Law Section 4201 and have the right to authorize cremation of the remains of the deceased. My/Our relationship to the deceased is as follows:
    (Number and Description)
  • (Initial ALL THREE of the following)
  • I/We hereby affirm that the body of the deceased does not contain a battery, battery pack, power cell, radioactive implant, or radioactive device and that any such materials were removed prior to the execution of this Authorization Form. Failure to remove these items prior to cremation may result in harm to the crematory and crematory personnel.
  • I/We affirm that instructions have been given to (Funeral Director Name listed below) regarding the removal of any personal property or other thing of value which any person signing below or any family member of the deceased wishes to preserve. (Crematory Name listed above and below) is not responsible for the removal of personal items from the container or from the remains of the deceased. Personal items left in the container or with the remains will be destroyed by the cremation process and cannot be retrieved after cremation.
  • I/We hereby authorize (Crematory Name listed below) to cremate the remains of the deceased.

    The person authorized to receive the cremated remains of the deceased from the crematory is:
  • If for any reason the person named above does not take possession of the cremated remains,
  • is authorized to give possession of the remains to
  • by delivery in person or by registered mail.
  • I/We understand that if the remains are not claimed within 120 days of cremation,
  • may dispose of the remains in an irretrievable manner, such as by scattering.

    (Initial ONE of the following)
  • An urn to be used as a container for the cremated remains has been purchased from
  • and is described as follows:
  • I/We understand that if the urn is too small to hold the entire cremated remains, an additional rigid container may be used for delivery.
  • OR
  • An urn is not yet purchased. I/We understand that if no urn is purchased or otherwise provided
  • will place the cremated remains in a rigid temporary container for delivery.
  • This Authorization Form was provided by
  • and is signed by the funeral director as witness to its execution.

    I/We have received a completed copy of this Authorization Form.

    The person(s) identified below is/are the person(s) in control of disposition, who by signing this Authorization Form, attest(s) to the accuracy and completeness of the information contained in this Authorization Form and authorize(s) the foregoing.

  • Date Format: MM slash DD slash YYYY
  • Witness

  • This field is for validation purposes and should be left unchanged.