THE COTTON CREMATORY AT COTTON CEMETERY

208 Main St., Richmond, Maine  04357

AUTHORIZATION DOCUMENT FOR CREMATION & DISPOSITION OF CREMATED REMAINS

 

1) Name of Funeral Establishment: Kincer Funeral Home

 

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***All pacemakers, radioactive, plastic  or fiberglass devices attached or implanted  must be removed prior to delivering the deceased to Cotton Crematory.***

 

4) Disposition of Cremated Remains: Container

Eventually the cremated remains will be interred or inurned in a cemetery or will be scattered     _x_ yes     ___ no

Deceased will be transported to Cotton Crematory in the following type of container/casket:  _Cremation Tray_______________

The authorizing person requests that the cremated remains be placed in temporary:  _____ cardboard  _x_ plastic _____  an urn provided by the funeral establishment or the family

 

5) The staff at Cotton Crematory is requested by the authorizing person to make the following disposition of the cremated remains: 

_____  ship by Priority Mail  Express to ______________________________________________________________________

_____  deliver by vehicle  to funeral establishment to ___________________________________________________________

__X__     pick up at Cotton Crematory _X_ by agent of the funeral establishment    

 

6) Declaration of Authority by Authorizing person(s) and Limitation of Liability

**As the undersigned Authorizing Person(s) , I hereby request and authorize Cotton Crematory, in accordance with and subject to the statutes and laws governing crematories in the State of Maine, as well as in accordance to professional standards regarding cremations,  to cremate the human remains of the deceased and to arrange the disposition of the cremated remains as set forth on this form.

 ** I, the undersigned, certify and represent that I have the right to make such authorization under the laws of the state of Maine in accordance with 22 MRSA 2843-A custody of remains of deceased persons. 

** I, the undersigned, have the option to identify the unprepared (NO SANITARY CARE OR EMBALMING) human remains delivered to the funeral establishment as the deceased and have authorized the funeral establishment to deliver the deceased to Cotton Crematory for cremation.  Otherwise, I, the undersigned, have elected to waive the right to identify the human remains at the funeral establishment.

** Further, I, the undersigned,  am/are not aware of any objection to this cremation by any spouse, child, parent, sibling, or other family member of the deceased. 

** I/We, are aware that ANY metals that remain after the cremation process will be disposed of in the Cotton Crematory metal recycling bin. Any request of metals to be returned, will need to be done prior to cremation.

** I/We, the undersigned, acknowledge that cremation is final and irreversible and agree to indemnify, defend, and hold harmless Cotton Crematory, its officers, agents, and employees of and from any and all claims, demands, causes or causes of action, and suits of every kind, nature, and description, in law or equity, including any legal fees, costs, and expenses of litigation, arising as a result of, based upon, or connected with this authorization and the resulting cremation and disposition of the cremated remains, excepting only acts of willful negligence.

** I/We, the undersigned, acknowledge that cremation is  final and  irreversible and agree to indemnify, defend, and hold harmless Cotton Crematory, its officers, agents, and employees of and from any and all claims, demands, causes or causes of action, and suits of every kind, nature, and description, in law or equity, including any legal fees, costs, and expenses of litigation, arising as a result of, based upon, or connected with this authorization and the resulting cremation and disposition of the cremated remains, excepting only acts of willful negligence. 

** I/We, the  undersigned, authorize and instruct the funeral practitioner to remove all pacemakers, radioactive, plastic  or fiberglass devices attached or implanted and to dispose of them prior to transporting the deceased to Cotton Crematory. 

**I/We, the undersigned, as authorizing person(s), acknowledge that I/we have read both sides of this document carefully and that by the signature(s) below,

**I/We, as the authorizing person(s) attests/attest to the accuracy of all representations contained on this cremation authorization form.

PLEASE READ BEFORE SIGNING BELOW

Procedures

Each cremation performed at Cotton Crematory  is done so by the staff with the highest degree of care, respect and professionalism in accordance with the laws of the state of Maine and with the policies, procedures, and requirements governing crematories.

Each cremation is performed individually.  A stainless steel identification disc bearing the cremation number is placed in the chamber during the crematory process.

Pacemakers, radioactive, mechanical, plastic and/or fiberglass devices or implements that may create a hazardous condition in the operational cremation chamber and subjected to heat.  It is the responsibility of the authorizing person(s), to list all devices (including implants, prosthetics, mechanical or otherwise) which may have been implanted or attached to the Decedent.  If the funeral home is not notified about such materials, and is not instructed to remove them, the authorizing person(s) will be responsible for any damages caused to Cotton Crematory, its equipment, or personnel.

The cremation container containing the deceased will be placed in the cremation chamber and will be totally and irreversibly destroyed by prolonged exposure to intense heat and direct flame.  During the cremation process, it will be necessary to open the cremation chamber and to reposition the remains of the deceased in order to facilitate a complete and thorough cremation.

Following a cooling period, the cremated remains, which will normally weigh several pounds in the case of an average-sized adult, will be swept or taken from the cremation chamber via brushing and vacuuming (using an industry-specific mechanical device).  The staff at Cotton Crematory will make every reasonable effort to remove all the cremated remains from the cremation chamber, but it is impossible to remove absolutely all particles, as some dust and other residue from the process are always left behind.  In addition, while every effort will be made to avoid commingling, inadvertent or incidental commingling of minute particles of cremated remains from the residue of previous cremations is a possibility.

After the cremated remains are removed from the cremation chamber, all non-combustible materials, such as bridgework and materials from the casket or container, such as hinges, latches, and nails, will be removed from the bone fragments.  These materials will be discarded.  After the bone fragments have been separated from the other material, they will then be mechanically processed (pulverized).  This process of crushing or grinding may cause incidental commingling of the remains with the residue from the processing of previously cremated remains.

After the cremated remains have been processed, they will be placed in the designated urn or container, along with the stainless steel identification disc bearing the cremation number.  In the event the urn or container for the cremated remains is insufficient to accommodate all the cremated remains, any excess cremated remains will be placed in a secondary container and will be returned to the funeral establishment or authorized person, together with the primary urn or container.

Cotton Crematory uses a dual numbering system.  As already mentioned, a stainless steel identification disc bearing the cremation number is placed in the cremation chamber during the cremation and is then placed with the cremated remains in the container or urn. 

Cremated remains will only be released, delivered, mailed or disposed of by Cotton Crematory of the funeral home in a professional and respectful manner, in accordance to the highest professional standards and all applicable laws, according to the direction and consent given on the front of this form.  Cremated remains, if shipped, will be shipped via Priority Mail with a tracking number, delivery confirmation, and return receipt.

The obligations of Cotton Crematory shall be limited to the cremation of the decedent and the disposition of the cremated remains as authorized and directed on this form.  No warranties expressed or implied are made and damages shall be limited to the amount of the cremation fee paid.

 

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Charles Kincer
________________________________________________________________________________________________________________

Signature of funeral practioner; signature also cetifies that any pacemaker, prosthesis, casts, or implants have been removed.

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Kincer Funeral Home
130 Pleasant Street
Richmond, ME 04357
207-737-4395
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