Cremation Authorization Information

Name of member or deceased

Name*

First Middle Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

At-Need or Pre-Need*

At Need
Pre Need

Disclosures Concerning the Cremation Process

It is our policy to provide information concerning the cremation process so that our client families are fully informed. These disclosures are provided in the interest of satisfying any questions and allaying any concerns you may have. The cremation, processing and disposition of the decedents remains will be performed in accordance with New Hampshire Revised Statutes Annotated 325-A, New Hampshire Code of Administrative Rules Chapter He-P 600, or in accordance with Vermont Statutes Annotated title 18, Chapter 107, Subchapter 001, Paragraph 5201, and any and all other governing rules and the policies, procedures and requirements of Phaneuf Funeral Homes and Crematorium. Cremation will only take place after all of the following conditions have been satisfied: (a) all scheduled ceremonies and viewing have been completed; (b) at least 48 hours have transpired since the death occurred (no waiting period is required in the case of death resulting from a contagious or infectious disease and the Cremation Society of New Hampshire reserves the right to perform the cremation thereafter according to its own schedule); (c) the burial permit has been issued along with a copy of the signed death certificate and cremation authorization form; (d) the NH medical examiner viewed the deceased prior to cremation, completed and signed the Certificate By Medical Examiner For Cremation Form NHDOJ-29 and authorized the cremation to take place or the VT Medical Examiner has authorized the cremation to take place per 18 V.S.A. §5201(b) and signed the Medical Examiner’s Permit to Cremate form VDH-OCME-CP-01/2011; (e) the decedent has been wrapped in a leak proof pouch and placed in the cremation container; (f) pacemakers, prosthetic devices, silicon implants or other radioactive implants have been removed; (g) no objections concerning the cremation have been raised; (h) the cremation and our charges have been paid in full; and (i) any items of value delivered to the crematory authority with the human remains must be listed along with instructions as to how the items should be handled on a separate form.Cremation is performed by placing the deceased a cremation container and then placing the container into a cremation chamber or retort, where they are subject 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 or driven off, except bone fragments (calcium compounds) and metal (including dental gold and silver and other non-human materials) as the temperature is not sufficient to consume them. Phaneuf Funeral Homes and Crematorium, at its sole discretion, reserves the right to remove all noncombustible materials before cremation and discard them in a non-recoverable manner. Due to the nature of the cremation process any personal possessions or valuable materials, such as dental gold or jewelry (as well as body prosthesis or dental bridgework), that are left with the deceased and are not removed from the container prior to cremation will be destroyed or if not destroyed, will be disposed. Following a cooling period, the cremated remains, which will normally weigh several pounds in the case of an average size adult, are swept or raked from the retort. We make every reasonable effort to remove all of the cremated remains from the retort, but it is impossible to remove all of them, as some dust and other residue from the process is always left behind. In addition, while every effort is made to avoid commingling, inadvertent or incidental commingling of minute particles of cremated remains from the residue of previous cremations is possible. After the cremated remains are taken from the retort, all noncombustible materials (insofar as possible) are separated and removed from the human bone fragments by visible or magnetic selection and are disposed of in a non-recoverable manner. When the cremated remains are remove from the retort and after they have been separated from other material, they are then mechanically processed (pulverized). This process of crushing or grinding may cause incidental commingling of the remains with residue coming from the processing of previously cremated remains. These granulated particles will be virtually unrecognizable as human remains.

Authorization*

Authorization for Custody, Cremation, and Final Disposition: By checking this box, signing below, and submitting this form, I acknowledge and agree to the following: That I authorize and request the Cremation Society of New Hampshire or its agent, in accordance with its rules and regulations, and any applicable laws or regulations, to take possession, cremate, and carry out the final disposition as indicated on this form. That I have read and fully understand this on-line form and the section entitled “Disclosures Concerning the Cremation Process”, including the paragraphs regarding the processing of the cremated remains and the disposition of gold or silver, bridgework or other dental material, jewelry, or mementoes that are not removed prior to the Cremation Society taking custody of the remains. That a General Price List has been made available to me either on this website or in person. That I have the legal right to make these arrangements and assume legal responsibility for payment along with such additional services and/or items ordered by me.

I agree

Electronic Signature:

(In accordance with RSA 294-D New Hampshire Digital Signature Act)

Full legal name of member or individual authorized to make cremation arrangements:*

Electronic signature confirmation:*

Disclosures Concerning Charges
Charges are only for those items you selected or that are required. If we are required by law or by a cemetery or crematory to use any items, we will explain the reason in writing below and on the itemized statement which you may print out upon completion of this transaction and which you will receive at the time of services. Legal, cemetery, crematory, or other requirements compelling the purchase of any item listed herein: - crematory required suitable solid cremation container for cremation which is already included at no charge in all of our cremation packages.

Acceptance This establishment agrees to provide services, merchandise and cash advancement as selected by the above signed and as reflected on the statement of goods and services.

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