Elemental Cremation & Burial
Name of Decedent: [calc_name]
Date of Birth: [DOB] Date of Death: [DOD]
I the undersigned (the “Authorizing agent”) hereby authorize and request that Elemental Cremation & Burial prepare the body of the decedent for burial and to deliver the decedent to [cemetery_name], my/our cemetery of choice, for burial or entombment. I also warrant that I will make arrangements directly with the cemetery regarding the right to interment, entombment or burial and arrange payment for funeral home and cemetery costs prior to delivery of the body to the cemetery.
Schedule & Container Requirement: The Cemetery may perform the burial upon receipt of the remains, at its discretion, and according to its time schedule, as work permits, unless they have received any further authorization or instructions from me/us as listed below. The Cemetery requires that the remains be placed in a container for burial. Most cemeteries also require a vault or grave liner.
Choice of casket or burial container: [calc_casket]
Date and Time of Burial Service: [service_time_date]
Authority to Sign: I state, represent and warrant that I am authorizing disposition in writing pursuant to
RCW 68.50.160 :
Right to control disposition of remains—Liability of funeral establishment or cemetery authority—Liability for cost.
- A person has the right to control the disposition of his or her own remains without the predeath or postdeath consent of another person. A valid written document expressing the decedent’s wishes regarding the place or method of disposition of his or her remains, signed by the decedent in the presence of a witness, is sufficient legal authorization for the procedures to be accomplished.
- Prearrangements that are prepaid, or filed with a licensed funeral establishment or cemetery authority, under RCW 18.39.280 through 18.39.345 and chapter 68.46 RCW are not subject to cancellation or substantial revision by survivors. Absent actual knowledge of contrary legal authorization under this section, a licensed funeral establishment or cemetery authority shall not be held criminally nor civilly liable for acting upon such prearrangements.
- If the decedent has not made a prearrangement as set forth in subsection (2) of this section or the costs of executing the decedent’s wishes regarding the disposition of the decedent’s remains exceeds a reasonable amount or directions have not been given by the decedent, the right to control the disposition of the remains of a deceased person vests in, and the duty of disposition and the liability for the reasonable cost of preparation, care, and disposition of such remains devolves upon the following in the order named:
- The person designated by the decedent as authorized to direct disposition as listed on the decedent’s United States department of defense record of emergency data, DD form 93, or its successor form, if the decedent died while serving in military service as described in 10 U.S.C. Sec. 1481(a) (1)-(8) in any branch of the United States armed forces, United States reserve forces, or national guard;
- The designated agent of the decedent as directed through a written document signed and dated by the decedent in the presence of a witness. The direction of the designated agent is sufficient to direct the type, place, and method of disposition;
- The surviving spouse or state registered domestic partner;
- The majority of the surviving adult children of the decedent;
- The surviving parents of the decedent;
- The majority of the surviving siblings of the decedent;
- A court-appointed guardian for the person at the time of the person’s death.
- If any person to whom the right of control has vested pursuant to subsection (3) of this section has been arrested or charged with first or second degree murder or first degree manslaughter in connection with the decedent’s death, the right of control is relinquished and passed on in accordance with subsection (3) of this section.
- If a cemetery authority as defined in RCW 68.04.190 or a funeral establishment licensed under chapter 18.39 RCW has made a good faith effort to locate the person cited in subsection (3)(a) through (g) of this section or the legal representative of the decedent’s estate, the cemetery authority or funeral establishment shall have the right to rely on an authority to bury or cremate the human remains, executed by the most responsible party available, and the cemetery authority or funeral establishment may not be held criminally or civilly liable for burying or cremating the human remains. In the event any government agency or charitable organization provides the funds for the disposition of any human remains, the cemetery authority or funeral establishment may not be held criminally or civilly liable for cremating the human remains.
- The liability for the reasonable cost of preparation, care, and disposition devolves jointly and severally upon all kin of the decedent in the same degree of kindred, in the order listed in subsection (3) of this section, and upon the estate of the decedent.
______ (initials) I have read and understood RCW 68.50.160
I have the right and hereby authorize the burial of the deceased. I am/We are not aware of any living person with a superior right to authorize the burial of the deceased and I am/we are not aware of any contract or instruction (including any pre-arranged funeral plan) made by the deceased objecting to burial or providing for disposition other than by burial.
I warrant that all representations and statements contained in this form are true and correct. These statements are being relied upon by the Elemental Cremation & Burial and the cemetery.
I hereby state that I am the closest living next of kin of the decedent or are otherwise empowered and authorized to execute this authorization according to all state and local laws.
I am aware of no objection to this burial by the spouse, any child, parent or sibling of the Decedent, or of provision of any contract or instructions made by the Decedent.
I have either identified or waived my rights of identification of the human remains that I released to Elemental Cremation & Burial, as the decedent. All personal property, clothing and or valuables have been removed from the remains or I hereby order them buried with the remains. I understand that any personal property, clothing or valuables, including dental gold, on or with the body will be buried, and therefore will not be recoverable.
I hereby agree to indemnify and hold harmless, Elemental Cremation & Burial, its officers, directors, agent and employees, from any claim, liability, cost or expense resulting from their reliance on or performance consistent with the direction, declaration, representation, authorizations and agreements herein, including but not limited to, claims brought by any other persons claiming the right to control the disposition of the decedent.
By execution, the undersigned warrant(s) that all representations and statements contained herein are true and correct. These statements are being relied on by the cemetery and the undersigned has read and understood the provisions of this document.
SIGNATURE OF AUTHORIZED AGENT: ________________________________________
[Firstname, Lastname, Relation]