Elemental Cremation & Burial


Disposition of the cremated remains of [Firstname, Lastname], shall be made as instructed:

________ (initials) I have directed the division of the remains of the above named decedent by Elemental Cremation & Burial as described below.      

The representative instructs Elemental Cremation & Burial to divide the cremated remains of the decedent into the number of portions that are set forth below. The representative acknowledges and agrees that it is impossible to provide equal shared of the decedent to each of the recipients listed below and instructs Elemental Cremation & Burial to use reasonable efforts to divide and distribute similar shares of the cremated remains to the recipients.

Number of apportionments: [calc_apportionment]

Description of containers to be used: [calc_urn]


Recipients of Remains:

I wish that the cremated remains be released to the following person(s) after the apportionment has taken place:

[Name1, Name1 phone]

[Name2, Name2 phone] 

By initialing next to the appropriate box above and by my signature below I hereby certify that I have the right to direct the disposition of

the remains of the above-named decedent including the apportionment thereof. Additionally, I understand that in the event that the cremated remains remain unclaimed for more than 90 days, I will be contacted by certified mail at the address above.  I will have 10 business days to claim the cremated remains or otherwise provide for their disposition.  If I do not respond within the stated time period I hereby authorize Elemental Cremation & Burial to make disposition of the cremated remains in any legal manner and within any time period it deems appropriate.   I further understand that 30 days of cremated remains storage will be provided free of charge. Past the initial 30 days I will be charged and agree to pay a $1.00 per day fee for storage until permanent disposition is made.



SIGNATURE OF AUTHORIZED AGENT:  ________________________________________

[Firstname, Lastname, Relation]