I (We), the undersigned (the "Authorizing Agent(s)"), hereby authorize and request W.C. , in accordance with and subject to its rules and regulations, and any applicable state/provincial or local laws or regulations, to create the human remains of
and to arrange for the final disposition of the cremated remains, as set forth on this form.
I (We) have identified the human remains that were delivered to the funeral home as the decedent, and have authorized the funeral home to deliver the decedent to W.C. , for cremation. Otherwise, I (We) have elected to waive the right to identify the human remains at the funeral home.
I (We) have read the attached document entitled "W.C. Policies, Procedures, and Requirements," and hereby authorize W.C. to perform the cremation of the decedent in accordance with that document.
Identification
Pacemakers, Prostheses, Silicon, and Radioactive Implants
All pacemakers and radioactive implants must be removed prior to delivering the decedent to W.C.
W.C. is authorized to perform the cremation upon receipt of the human remains, at its discretion, and according to its own time schedule, as work permits, without obtaining any further authorization or instructions.
Final Disposition
After the cremation has taken place, the cremated remains have been processed and the processed cremated remains placed in the designated receptacle, W.C. will arrange for the disposition of the cremated remains as follows, and the Authorizing Agent(s) hereby authorizes W.C. to release, deliver, transport, or ship the cremated remains as specified.
Authority of Authorizing Agent
I (we), the undersigned, hereby certify that I am the closest living next of kin of the decedent and that I am related to the decedent as his/her
or that I otherwise serve (served) in the capacity of Authorizing Agent/Next of Kin to the decedent, that I have charge of the remains of the decedent and as such possess full legal authority and power, according to the laws of the state/province of Georgia, to execute the authorization form and to arrange for the cremation and disposition of the cremated remains of the decedent. In addition, I am aware of no objection to this cremation by any spouse, child, parent, or sibling.
