NOTICE:  This is a legal document.  It contains important provisions concerning cremation.  
Cremation is irreversible and final.  Read this document carefully before signing.
CREMATION AUTHORIZATION & ORDER FOR DISPOSITION
To:  Cremation Society of Orange Coast _____Macera Crematory____________(Provider/s)  
The undersigned hereby certify and represent that they are the legal custodian (s), having full legal authority 
to authorize the cremation, processing and disposition of the named decedent, and hereby request and authorize,
 Providers to make removal, take possession of, make arrangements for and to cause the cremation, processing 
and disposition of the remains of:
1.  Name of decedent:_______________________________________________________
    Address: _______________________________________________________________
in accordance with and subject to the terms and conditions set forth in this Authorization, the Provider's rules 
and regulations and any applicable state or local laws, rules or regulations.  I/we agree jointly and severally to 
hold the Provider, its officers, agents, employees and the below named funeral director, harmless from any and 
all loss, costs, or damages it or they may suffer or incur by reason of acting upon this authorization and order.
I/we the undersigned understand and acknowledge that due to the nature of the cremation process, the entire 
amount of fragment remaining MAY not be included in the urn or container selected and that valuable material,
 including dental gold will either be destroyed or not be recoverable.  (See disclosure)
2. I/We the undersigned further State: (Must choose one)

[      ]  The deceased has no implanted device or prosthesis [      ]  The deceased has an implanted device or prosthesis and I/we authorize and order removal and disposition of same prior to cremation, if necessary

Describe device: __________________________________________ [  ] Heart pacemaker     Implanted mechanical devices may create a hazardous condition when placed in a cremation chamber.  I/we the undersigned agree  that in the event of failure to notify the funeral director or Provider or others responsible for the removal of such a device, that  the undersigned will be liable for any damages to the crematorium and/or injury to crematorium personnel.

3.  Disposition of Cremated remains  (Must choose one)
I/we the undersigned hereby order the disposition of the cremated remains as follows:    

	[     ]	Burial at sea (Location of Scattering)___________________________________________
	[     ]	Burial in Cemetery (Name of Cemetery) ________________________________________
	[     ]	Release to Family (Name of Person)___________________________________________

In the event that I have not called for the cremated remains as agree, or directed the final disposition within 30 days of cremation, disposition can be made at the discretion of the Provider/s.  I release any liability for this performance and I assume responsibility for the cost of the final disposition.  
DISCLOSURE  (required by California State Law Cremation Standards Act January 1, 1994)  The human body burns with the
 casket, container, or other material in the cremation chamber.  Some bone fragments are not combustible at the incineration
 temperature and, as a result, remain in the cremation chamber.  During the cremation, the contents of the chamber may be moved 
to facilitate incineration.   The chamber is composed of ceramic or other material which disintegrates slightly during each cremation 
and the product of that disintegration is co-mingled with the cremated remains.  Nearly all the contents of the cremation chamber, 
consisting of the cremated remains, disintegrated chamber material and small amounts of residue from previous cremations are 
removed  together and crushed, pulverized or ground to facilitate inurnment or scattering.   Some residue remains in the cracks 
and uneven places of the chamber.  Periodically, the accumulation of this residue is removed and interred in a dedicated cemetery
property or scattered at sea. 

A person having the right to control disposition of cremated remains may remove the remains in a durable container from the place of cremation or interment, pursuant to Section 7054.6 of the Health and Safety Code; and if the cremated remains container cannot accommodate all cremated remains of the decedent, the crematory shall provide a larger cremated remains container at no additional cost, or place the excess in a second container that cannot easily come apart from the first, pursuant to Section 8345 of the Health and Safety Code.
(California State Law Business & Professions Code 7685)

I/we have read the foregoing disclosure:
4.   SIGNATURE of person(s) authorizing cremation and disposition.   Date_____________

_____________________________________
                                         Signature
_____________________________________
                                       Relationship   
_____________________________________
                                         Address