Cremation Authorization Form

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Certification of Authorized Agents

A) I, the undersigned, hereby certify that I am the Legal Custodian and Authorizing Agent(s) of the herein named deceased, having full legal authority under State Law, to authorize the cremation, processing and disposition of the deceased and request SouthCare Cremation & Funeral Society, hereinafter referred to as SCFS, to provide cremation, processing and disposition of Decedent (name below) whose date of death is listed below in accordance with and subject to: (1) terms and conditions set forth in this form, (2) company rules and regulations, entitled Policies and Procedures.

Full Name of Deceased *
Initials of Authorized Agent(s) *
Visual Identification

B) Because cremation is irreversible, identification of the deceased is encourged by SCFS and one of the options below must be chosen.

Initials of Authorized Agent(s) *
Visual Identification Options *
I Do Not Wish to View the Deceased

Individual Release and Waiver of Right to View Deceased

By executing this Waiver Release form, as Authorizing Agent(s), the undersigned warrants that all representations and statements contained on this form and made to the funeral director and staff are true and correct and that these statements were made to authorize SouthCare Cremation & Funeral Society to cremate the human remains of the herein named deceased and that the undersigned has read and understands the provisions contained on this form.

I, the undersigned, hereby certify that I am the Legal Custodian and Authorizing Agent(s) of the herein named deceased, having full legal authority under State Law, to authorize the cremation, processing and disposition of the deceased and request SouthCare Cremation & Funeral Society, hereinafter referred to as SCFS, to provide cremation, processing and disposition of Decedent name listed below, whose date of death is listed below. I have chosen to waive the right of identification and assume full responsibility on behalf of such waiver as the Authorizing Agent(s), I hereby agree to indemnify, defend and hold harmless SCFS and its officers, agents and employees, of and from any and all claims, demands, causes, actions and suits of every kind, nature and description, in law or equity, including any legal fees, costs and expenses of litigation, arising as a result of, based upon, or connected with waiving my right of identification; including failure to properly identify the deceased or the human remains transported to SCFS, for the purpose of cremation. I agree to hold harmless SCFS from any and all claims brought by waiving my right to identify the deceased individual prior to cremation, or any other action performed by SCFS, its officers, agents or employees, pursuant to this authorization, excepting only acts of willful neglect.

Authorized Agent #1
Address
Authorized Agent #2 (if applicable)
Address
Authorized Agent #3 if applicable)
Address
Address