Iowa Cremation Authorization Form – Fill Out and Use This PDF

INITIAL(s)

INITIAL(s)

AUTHORIZED PERSONS ACKNOWLEDGMENT

I (We) represent that I (We) in accordance with Iowa Administrative Code/Rules [ 645-100.1(156) ] Current Authorized Person List Rights and Responsibilities fall into the list of Authorized Persons as stated below. I (We) represent that to the best of my (our) knowledge there is no person(s) of higher authority and I (we) posses full legal authority and power, according to the laws of the state of Iowa to execute this authorization and to arrange for the cremation and disposition of the cremated remains of the decedent. I (We) also state that I (We) take full responsibility for this authorization to cremate and assume all responsibility for its directive.

POSITIVE IDENTIFICATION

I (We) represent here that positive identification of the decedent stated above has been made or I (We) have elected to waive my (our) right to do so and understand and waive all rights associated with this decision and assume full responsibility for this decision. I (We) agree to hold harmless and indemnify as provided in the section above.

INITIAL(s)

CREMATION ACKNOWLEDGEMENT

I (We) represent here that I (We) understand I (We) have the right to revoke this authorization and instruct the crematory to cancel the cremation provided such instruction is received in writing prior to the beginning of the cremation. In the event the cremation has been started, the authorization stands and we hold harmless all parties involved directly or indirectly with the the Crematory resulting from this cremation. I (We) also acknowledge and understand that in the event there is written notification prior to the start of the cremation that a person(s) of suspected equal or superior right exists and/or opposes the cremation, the Crematory reserves the right to delay the cremation until such time the matter is resolved in a manner acceptable to the Crematory or a court order is presented authorizing the cremation. In such an event, or in order to comply with the laws of this state, the Crematory reserves the right to preserve the remains in accordance with current laws in this state which may include refrigeration and/or arterial or hypodermic embalming. If embalming is performed to comply with current State Laws I (We) do hereby grant permission and understand I (we) may be liable for additional charges that pertain as listed on the current General Price List.

INITIAL(s)

DISPOSITION RESPONSIBILITY

I (We) understand that in accordance with Iowa Administrative Code/Rules [ 645-100.10(6)c ] that if after a period of sixty (60) days from the date of the cremation, the authorizing person or designee has not instructed the funeral director to arrange for the final disposition of the cremated remains, the Crematory may dispose of the remains in any manner permitted by this Rule. The Crematory, however, shall keep a permanent record identifying the site of final disposition. The authorizing person shall be responsible for reimbursing the Crematory for all reasonable expenses incurred in disposing of the cremated remains. Any entity that was in possession of cremated remains prior to the effective date of these Rules may dispose of them in accordance with this Rule.

INITIAL(s)

CREMATION PROCESS ACKNOWLEDGMENT

I (We) represent and understand that cremation is performed by placing the decedent in a cremation container or on a cremation tray and then placing the cremation container or tray into a cremation chamber or retort where they are subjected to intense heat and flame. Through the use of natural gas, incineration of the container and its contents is accomplished and all substances are consumed, except bone fragments (calcium compounds) and metal (including gold and silver and other non-human materials) 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, dental work and prostheses that are left with the decedent and are not removed prior to the cremation will be destroyed , or if not destroyed, will be disposed of. Following a cooling period, the cremated remains, (which will normally weigh several pounds in the case of an average sized adult), are swept or raked from the retort. The Crematory makes all reasonable attempts to remove all the cremated remains from the chamber, but it is impossible to remove them all, as such, some dust and other residue from the process may be left behind. In addition, while efforts are made to avoid comingling, inadvertent or incidental comingling of minute particles of cremated remains from the residue of previous cremations is possible. All possible non-human particles are separated from the cremated remains and the crematory reserves the right to dispose of this non-human material at its sole discretion. The cremated remains are then mechanically pulverized into a consistency that will be virtually unrecognizable as human remains. If the container the cremated remains are to be placed in is insufficient to hold all cremated remains, the remaining cremains will be placed in a second temporary container.

INITIAL(s)

MEDICAL DEVICES

I (We) represent here that to the best of my/our knowledge there are no medical devices, materials, or implants that may be explosive or potentially hazardous to equipment or persons performing the cremation. In the event the decedent does have such a device, I (We) authorize the removal of such devices as deemed necessary by the crematory to prevent harm to equipment or person and understand these items will be discarded as deemed appropriate by the crematory and will not be returned.