I, (hereinafter referred to as the “Authorized Representative”) hereby certify that I have the legal right pursuant to 20 Pa.C.S. 305 to sign this cremation authorization form.
I hereby further certify that I am 18 years of age or older, of sound mind and I am not aware of any living person who has a superior or equal priority to my right regarding the right to dispose of the Decedent’s Remains. In the event there is another living person who has a superior or equal right to mine, I hereby represent that I made all reasonable efforts to contact such person(s) to no avail and I further represent that I have no reason to believe that such person(s) would object to the cremation of the Decedent’s Remains. I further certify that the Decedent’s Remains do not contain a pacemaker or any other material or implant that may be potentially hazardous or cause damage to the cremation chamber or the person performing the cremation on behalf of the Crematory. I understand,acknowledge and accept that due to the nature of the cremation process, any valuable material, such dental gold, jewelry etc. will be destroyed otherwise I accept the fact that such items will not be recoverable and I hereby understand that the Decedent’s Cremated Remains shall be returned in a uniform crushed state to the best of the Crematory’s ability and that Decedent’s Cremated Remains shall be returned in a temporary cardboard container unless I otherwise instruct in writing.
I hereby release,discharge, defend, indemnify and hold harmless, the Crematory, including its managers, officers, members, employees, agents in its corporate capacity (and their individual capacities), and its respective successors and assigns, against any and all claims, expenses, including legal fees, actions, suits and citations and from any and all liability and any and all loss of any kind that may arise in any manner directly or indirectly related to the cremation of the Decedent’s Remains, including, but not limited to, any and all damage or loss caused directly or indirectly by the shipment of the Decedent’s Cremated Remains.