We are required to have the original, signed Cremation Authorization form on file. This form may be printed and mailed, faxed, or brought in to us. If you would prefer to download this form in the Adobe PDF format, click here. You may also want to see our Basic Information Form, which provides info for death certificate and other purposes.
Authorization & Direction for Cremation and Disposition of Cremated Remains |
Memorial Alternatives Burial & Cremation Service The undersigned (Hereinafter referred to as the "Authorized representative(s)" herby certify that they are the closest living legal next-of-kin of the herein named
deceased, having full legal authority to authorize and direct the cremation, processing and disposition of the cremated remains of the deceased, authorize and direct MEMORIAL ALTERNATIVES to take possession of and make arrangements
for the cremation, processing and disposition of the remains of: ______________________________________________________________Deceased Date of death____________________________________________________
Disposition of Cremated Remains ___Authorized representative(s) to return to MEMORIAL ALTERNATIVES for cremated remains within thirty days. ___Send cremated remains by registered mail to: a $30.00 fee will apply for
CONUS, overseas is additional ___Other______________________________________________________________________ The actual cremation will take place at Myrtle Park Crematorium or Rosedale Crematory, cremated
remains consist primarily of bone fragments, which are reduced to permit their placement in an urn or other suitable container. The undersigned agree to release and hold harmless MEMORIAL ALTERNATIVES, its affiliates
and their agents, and employees, from any and all damages, liabilities, claims for relief or causes of action, including but not limited to costs, expenses, and attorneys fees, in connection with the cremation and disposition of
the cremated remains as authorized and directed herein. Pacemakers and prostheses, as well as any other mechanical or radioactive devices or implants in the decedent, may create a hazardous condition when placed in the cremation
chamber. It is imperative that they be removed prior to cremation. If the funeral home is not notified about such devices and implants, and not instructed to remove them, then the person(s) authorizing the cremation
will be responsible for any damages caused to the crematory or crematory personnel by such devices or implants. I have instructed the funeral home to remove or arrange for the removal of these devices and to properly
dispose of them prior to the cremation process taking place. No cremation can take place without written authorization (including Facsimile) from the authorized Next-of-Kin of
the deceased. The closest NOK is as follows. SPOUSE, CHILDREN, GRANDCHILDREN, PARENTS, SIBLINGS, NIECES and NEPHEWS, GRAND-NIECES and NEPHEWS, GRANDPARENTS, AUNTS and UNCLES, FIRST COUSINS: all persons within the
same degree of Kinship must authorize the cremation. Signatures of Authorized Representatives for cremation and final disposition.
NAME________________________ NAME___________________________ ADDRESS_____________________ ADDRESS________________________
______________________________ ________________________________ SIGNATURE___________________ SIGNATURE ______________________
RELATIONSHIP________________ RELATIONSHIP ___________________ NAME________________________ NAME____________________________
ADDRESS_____________________ ADDRESS_________________________ ______________________________ _________________________________
SIGNATURE___________________ SIGNATURE _______________________ RELATIONSHIP________________ RELATIONSHIP ____________________
2432 Fuller NE
Grand Rapids, MI 49505
Mark A. Petricevic-Manager
Telephone 616-363-3700
Fax 616-363-3740
Initials of NOK___________________________
Description of the Cremation Process. |
The Cremation Process All cremations are performed individually. Cremation is performed by placing the deceased in a casket or other
container and placing the casket or container into a cremation chamber or retort, where they are subjected to intense heat and flame. During the cremation process, it may be necessary to open the cremation chamber and
reposition the deceased in order to facilitate a complete and thorough cremation. Through the use of a suitable fuel, incineration of the container and contents is accomplished and all substances are consumed or driven off,
except bone fragments (calcium compounds) and metal (including dental gold and silver and other nonhuman material) as the temperature is not sufficient to consume them. Due to the nature of the cremation process, any personal
possessions or valuable materials, such as jewelry, body prosthesis or dental work, that are left with the decedent and not removed from the casket or container prior to the cremation will be destroyed or if not destroyed, will be
disposed of by the crematory. As the casket or container will not normally be opened by the crematory (to remove valuables, to allow for a final viewing or for any other reason), arrangements must be made with the
funeral home to remove any such possessions or valuables prior to the time that the decedent is transported to the crematory. Following a cooling period, the cremated remains, which will normally weigh several pounds in the case
of an average size adult, are then swept or raked from the cremation chamber. The crematory makes a reasonable effort to remove all of the cremated remains from the cremation chamber, but it is impossible to
remove all of them, as some dust and other residue from the process are always left behind. In addition, while every effort will be made to avoid commingling, inadvertent incidental commingling of minute particles of cremated
remains from the residue of previous cremations is a possibility. After the cremated remains are removed from the cremation chamber, all non-combustible materials (insofar as possible), such as bridgework, and materials
from the casket or container, such as hinges, latches, nails, etc., will be separated and removed from the human bone fragments by visible or magnetic selection and will be disposed of by the crematory with similar materials from
other cremations in a non-recoverable manner. When the cremated remains are removed from the cremation chamber, the skeletal remains often contain recognizable bone fragments. Unless otherwise specified, after the bone
fragments have been separated from the other material, they will then be mechanically processed (pulverized). This process of crushing or grinding may cause incidental comminglingof the cremains with the residue from
the processing of previously cremated remains. These granulated particles of unidentifiable dimensions will be virtually unrecognizable as human remains. After the cremated remains have been processed, they will be
placed in the designated urn or container. The crematory will make a reasonable effort to put all of the cremated remains in the urn or container, with the exception of dust or other reside that may remain on the processing
equipment. In the event the urn or container provided is insufficient to accommodate all of the cremated remains, the excess will be placed in a separate receptacle. The separate receptacle will be kept with the primary
receptacle and handled according to the disposition instructions on the cremation authorization form. The crematory requires that all urns or containers provided be appropriate for shipping or permanent storage, and that in the
case of an adult, it is recommended that the urn or container be a minimum size of 200 cubic inches. Cremation is not final disposition, nor is placing the cremated remains in storage at a Funeral Home final disposition.
The cremation process simply reduces the decedent's body to cremated remains. These cremated remains usually weigh several pounds and measure in excess of 150 cubic inches. Some provision must be made for the final
disposition of these cremated remains. Therefore we mandate that arrangements for the final disposition be made at the time that cremation arrangements are being made and the cremation authorization is completed.
If the final disposition of the cremated remains has not been completed within 30 days of the cremation, then the Funeral Home and Crematory shall be authorized to arrange for the final disposition of the cremated remains in any
manner permitted by law. Such final disposition may include the commingling of the cremated remains with other cremated remains, and thereafter the cremated remains of the decedent will not be recoverable.
Signature_____________________________________________
Signature_____________________________________________
Signature_____________________________________________
Signature
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