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A LOVED ONE HAS PASSED
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TEMPLE PREVIEW
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DALLAS PREVIEW
Step
1
of
2
50%
Your Name
First
Last
Your Email
Your Phone #
Name of Deceased
Age
Date of Death
MM slash DD slash YYYY
Time of Death
Hours
:
Minutes
AM
PM
AM/PM
Location of the Deceased
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
If another person has an equal priority right to authorize cremation, the authorizing agent has made all reasonable efforts but failed to contact that person and believes the person would not object to the cremation and agrees to indemnify and hold harmless the funeral establishment and the crematory establishment for any liability arising from performing the cremation without the person's authorization .
Initial
List any valuables to include jewelry, personal effects, etc. that are being delivered to the crematory with the deceased and instructions for handling of said valuables.
THE DECEASED DOES ____ , DOES NOT ___ CONTAIN ANY TYPE OF IMPLANTED MECHANICAL OR RADIOACTIVE DEVICE. (please select one)
DOES
DOES NOT
SIGNATURE OF PERSON(S) AUTHORIZING CREMATION AND DISPOSITION
I/We warrant that all representations and statements mad herein are true and correct and that I have read and understand the provisions contained in this documents.
Signature
Relationship
Date
MM slash DD slash YYYY
Acknowledgement of Waiver of Right of Identification
(Required)
I, the undersigned Authorizing Agent do hereby waive my right of identification of the above named deceased person. I decline to view the remains of the deceased and acknowledge that the Funeral Director and/or Funeral Establishment will rely on the institution where death occurred for identification of said remains.
Signature of Authorizing Agent
Printed Name of Authorizing Agent & Relationship
Date of Acknowledgement
MM slash DD slash YYYY
Cremation Price
Price:
Mail or Scattered?
Mail - ($150) Please expect 20-30 days for your loved ones remains and death certificates to arrive.
Please Scatter the Ashes
Land or Offshore?
Land - (Free) Ashes are scattered on state-approved memorial gardens
Offshore - ($500) Includes a biodegradable urn and will be scattered off the Texas coast.
Mail Ashes to (if different from the previous address)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
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