Wages and Sons Gwinnett Chapel Crematory. ("Wages and Sons") requires that this Authorization for Cremation and Disposition Form ("Form") be completed and signed prior to the cremation. ALL PARTIES UNDERSTAND THAT CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS. It is important that you understand the cremation process that is described in Appendix A of this Authorization Form prior to signing it. We want you to fully understand the information provided in this Authorization Form, we will be pleased to answer any questions about the cremation process or other questions that you may have.
1. DECEASED INFORMATION
A. Identification
Name and address of Party or Parties providing the information to be relied upon and the approval for the actions required by this form:
Any and all parties shown above are hereinafter referred to as Authorizing Agent. If more than one person is acting as the Authorizing Agent they shall all be shown above. From this point forward the phrase Authorizing Agent shall apply to all shown above. No approval can be given unless it is approved by all Authorizing Agents. As Authorizing Agent, I/we have filled in the chart above.
I/We understand that any living person who meets the qualifications of any level above or equal to the one I/we filled in would have a superior
or equal right to act as the Authorizing Agent.
I/We do not have actual knowledge of the existence of any living person who has a superior or equal right to set as the Authorizing Agent.
I/We, individually and collectively, agree to hold Wages and Sons and any other party involved in this cremation harmless should we mislead
them with any of our statements is this Form.
B. Authorization And Identification
As Authorizing Agent, I/We represent that I/We have the right to authorize the cremation of the Decedent's remains and warrant:
As Authorizing Agent, I/We waived the right to identify decedent remains.
The Authorizing Agent has viewed the remains and positively identified them as that of the Decedent; OR
The personal representative of the Authorizing Agent has viewed the remains and positively identified them as that of the Decedent.
The personal representative of the Authorizing Agent is identified to Wages and Sons by the Authorizing Agent as
residing at
As Authorizing Agent, I/we have read and understand the description of the cremation process contained in Appendix A and authorize the
cremation, processing and pulverization of the remains of the Decedent. I/we further authorize Wages and Sons to proceed with the cremation.
C. Artifical Devices
Mechanical devices, artificial implants, pacemakers, and certain nuclear medicine residues may create a hazardous condition when placed in a cremation chamber and subjected to bight heat. Pacemakers, radioactive, silicon or other implants, mechanical devices or prostheses may create a hazardous condition when placed in the cremation chamber which can cause damage to the cremation chamber, the building housing the chamber and any operators-Of the cremation chamber. As Authorizing Agent, I have listed below all devices (including mechanical, prosthetic, implants, or materials), which may have been implanted in or attached to the Decedent. I have also identified if the Deceased was treated with any Radioactive Materials.
The Deceased was treated with Radioactive Materials
The remains of the Decedent do not contain any of the Devices nor has the Deceased been treated with Radioactive Material; OR
As Authorizing Agent, I/we instruct Wages and Sons to remove each Device listed above and to charge for its services in making or
arranging for such removal. Unless indicated directly below, Wages and Sons is to dispose of all such Devices. In any manner it sees fit and at any time.
D. Personal Property
All personal property and effects delivered with the remains of the Decedent to Wages and Sons, including jewelry, clothes, hair pieces, dental bridgework, eyeglasses,
and shoes, will be destroyed in the cremation process or otherwise discarded by Wages and Sons, in its sole discretion, unless specific instructions for delivery are given
below.
E. Eyewitnesses
The Authorizing Agent, being advised of their right to witness the placement of the deceased into the cremation chamber, shall accept or decline this offer in writing. Witnessing a cremation can be an emotional experience. Witnesses are assuming the risks involved and fully release Wages and Sons from any liability. To the extent permitted by Wages and Sons, the persons listed below are authorized to be present prior to and during the cremation of the Decedent's remains and for a time indicated below which may include the period during the removal of the cremated remains from the cremation chamber. Witnessing of any aspect of the cremation and processing procedure shall be in compliance with all applicable laws and any safety regulations. Witnesses should read Appendix A, which outlines the Cremation Process, so they will be aware of the procedure. If a witness cannot read English, the Authorizing Agent should make arrangements for someone to translate or read this to the Witness before the Cremation Process begins. If you desire witnesses, you must initial below, list the witness names, and all witnesses must sign an additional Cremation Witness Acknowledgment. This witnessing can be for the start of the cremation or for the entire cremation and processing of the cremated remains.
No witnesses; OR
Witnessing is to be only at the onset of the cremation.
Witnessing is to be for the entire time of the cremation.
Witnessing is to be for the entire time of the cremation and the processing of the cremated remains.
F. Time of Cremation
The cremation of the Decedent's remains cannot take place until all legal requirements as established by the State of Georgia have been fulfilled. The Authorizing Agent may arrange for the cremation to take place at a specified time or at the convenience of Wages and Sons upon the completion of the above legal requirements. The specific time would be used in the case of a Witnessing as specified in Section 1E. Our crematory is located at: 1031 Lawrenceville Highway, Lawrenceville, Georgia 30046
Please initial one of the following:
Wages and Sons may perform the cremation of the Decedent's remains at a time and date as its work schedule permits and without any further
notification to the Authorizing Agent; OR
Wages and Sons is to use its best efforts to schedule the cremation on
2. CREMATION CONTAINER AND URN
A. Casket or Cremation Container
Wages and Sons requires the remains of the Deceased be in a suitable container for cremation. The remains of Deceased are to be cremated in a combustible casket or alternative container that is capable of being completely closed, is resistant to leakage or spillage, is sufficiently rigid to be handled easily, and provides protection for the health and safety of Wages and Sons personnel and anyone else involved in transferring the body to Wages and Sons. Wages and Sons is authorized to inspect the casket or alternative container, including opening it if necessary. In the event that the casket or container does not meet the above requirements, Wages and Sons will notify the Authorizing Agent directly. Many caskets that are comprised primarily of combustible material also contain some exterior parts (decorative handles or rails) that are not combustible and that may cause damage to the cremation equipment. As Authorizing Agent, I authorize Wages and Sons, in its discretion, to remove and discard the non-combustible materials. I understand that some crematories will not accept metal or fiberglass caskets. I further understand that the casket or alternative container will be consumed as part of the cremation process.
B. Urn
An urn to hold the cremated remains may be purchased or provided by the Authorizing Agent but an urn is not required. If an urn is not purchased or provided; the cremated remains will be delivered in a rigid box with a liner.
3. Return of Cremated Remains of Deceased
4. Final Disposition
This date and location cannot be modified except in writing by all parties. Cremated remains shall only be released to any Authorized Agent or their Personal Representative.
We will make arrangements to pick up the cremated remains by the date and time above or we will forfeit our deposit and accept receipt of the
cremated remains to be delivered to the address of the Authorized Agent.
The Authorizing Agent shall be liable for the cost of such final disposition in a grave, crypt or niche and such costs shall be prepaid. Wages and Sons has no liability for the shipping of cremated remains if the costs for disposition at site are not prepaid.
The name and address for delivery are:
5. Certification and Indemnifications
I/We have the right and hereby authorize the cremation of the Deceased and the disposition of the cremated remains pursuant to the regulations of the Crematory and the instructions on this form. I/We agree to release and indemnify Wages and Sons, their officers, directors, agents and employees, from any claim, liability, cost or expense resulting from Wages and Sons reliance on or performance consistent with the directions, declarations, representations, authorizations and agreements herein. I/We release Wages and Sons from liability for the cremated remains upon delivery to a reputable common carrier. I/We agree that the Wages and Sons liability for future negligent acts (of itself or its agents or employees) is limited to a refund of the cremation fees paid to the Wages and Sons by me/us. I/We warrant that all representations and statements contained in this form are true and correct. These statements are being relied upon by Wages and Sons. Me agree to hold Wages and Son harmless from any attacks if they relied upon these statements which turn out to cause harm to anyone. I/We have read and understood all pages of this document.
