Cape Fear Crematory > Cremation Process Forms > Cremation Authorization Form

Cremation Authorization

Individual to be cremated:

Date of Death: (N/A if preneed)

Time of Death: (N/A if preneed)

Place of Death: (N/A if preneed)

Name of individual confirming the identity of descendent:

Name and address of Crematory that will perform the Cremation:

Cape Fear Crematory, 6765 Sandy Creek Rd.
Stedman, North Carolina 28391

By signing this form the Authorizing Agent(s) represent the following:

The Authorizing Agent(s) hereby certify, warrant, and represent that I/We have the right to authorize the cremation of the descendent and the Authorizing Agent(s) is (are) not aware of any living person who has a superior right to that of the Authorizing Agent(s) as set forth in G.S. 90-210.44; or, if there is another living person who does have superior right to the that of the Authorizing Agent(s), the Authorizing Agent(s) represent(s) that the Authorizing Agent(s) has(have) made all reasonable efforts to contact such person, has(have) been unable to do so, and has(have) no reason to believe that such person would object to the cremation of the decedent;

The Authorizing Agent(s) has(have) either disclosed the location of all living person with an equal right to that of the Authorizing Agent(s), as set forth in G.S. 90-210.44, or does(do) not know the location of any other living person with an equal right to that of the Authorizing Agent(s); and

To the best of the knowledge of the Authorizing Agent(s), the human remains contain a pacemaker or any other material or implant that may be potentially hazardous to the person performing the cremation.

DoesDoes not

The Authorizing Agent(s) hereby authorize(s) the above named Crematory to cremate the descendent, including the right to process or pulverize the cremated remains.

The Authorizing Agent(s) authorize(s) the person below to receive the cremated remains from the crematory licensee.

The final disposition of the cremated remains is to be as follows:

If no final disposition is given, the cremated remains will be held by the Crematory Licensee/Funeral Home for 30 days before they are disposed of, unless the cremated remains are received from the Crematory Licensee/Funeral Home prior to that time, in person, by the Authorizing Agent or his designee

If this cremation authorization form is being executed on a preneed basis, by checking the below boxes in the appropriate line, the Authorizing Agent indicates his or her election of said option

I do not wish to allow any of my survivors the option of canceling my cremation and selecting alternative arrangements, regardless of whether my survivors deem such a change to be appropriate.
I wish to allow only the survivors whom I have designated below the option of canceling my cremation and purchasing services and merchandise if they deem such a change to be appropriate.

Name of Survivors: (List all)

The Authorizing Agent(s) may specify in writing religious practices that conflict with Article 13 of Chapter 90 of the North Carolina General Statutes. The Crematory Licensee and Funeral Director shall observe these religious practices except when they interfere with cremation and a licensed crematory as specified under G.S. 90-210.43 or the required documentation and record keeping.

The Authorizing Agent(s) understand(s) that after this cremation authorization form is executed, the Authorizing Agent(s) only revoke the authorization and instruct the Crematory Licensee or Funeral Establishment to cancel the cremation or to release or deliver the human remains to another Crematory Licensee or Funeral Establishment by providing such instructions to the Crematory Licensee in writing prior to the commencement of the cremation. The Crematory Licensee shall honor these instructions provided that it receives such instructions prior to the commencement of the cremation of the human remains.

By execution this cremation authorization form, as Authorizing Agent(s), the undersigned warrant that all representations and statements contained on this form are true and correct, that these statements were made to induce the crematory to cremate the human remains of the Descendant, and that the undersigned have read and understand the provisions contained on this form.

1. Signature of Authorizing Agent:

Printed Name:

Realtionship to Descendant:

Full Mailing Address:

Telephone:

Date & Time:

2. Signature of Authorizing Agent:

Printed Name:

Relationship to Descendant:

Full Mailing Address:

Telephone:

Date & Time:

3. Signature of Authorizing Agent:

Printed Name:

Realtionship to Descendant:

Full Mailing Address:

Telephone:

Date & Time:

4. Signature of Authorizing Agent:

Printed Name:

Relationship to Descendant:

Full Mailing Address:

Telephone:

Date & Time:

The Funeral Director warrants that the human remains delivered to the Crematory Licensee are the human remains identified on this Cremation Authorization Form

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