Authorization for Cremation

Kiser Undertakings LLC dba Lone Star Cremation  ·  1804 Owen Court, Suite 112, Mansfield, TX 76063  ·  (817) 546-0108  ·  TFSC License #4372

This document covers the cremation and disposition of the remains of the deceased named on your order. The date and time of death are completed by Lone Star Cremation.

As the authorizing agent, you will confirm either that you possess the complete legal authority to authorize the cremation and are not aware of any person with a superior or equal priority right, or that other person(s) have an equal priority right, that all reasonable efforts to contact them have failed, that you believe they would not object, and that you agree to indemnify and hold harmless the funeral establishment and the crematory establishment for any liability arising from performing the cremation without that person's authorization.

You will also state whether you have arranged a viewing of the deceased prior to cremation, list any items of value delivered to the crematory with the deceased along with instructions for handling them, and tell us the manner of permanent disposition of the cremated remains if it is known. If the remains are to be shipped, you will provide the shipping address.

I hereby request and authorize KISER UNDERTAKINGS L.L.C dba LONE STAR CREMATION to take possession of and plan for the cremation of the human remains of the deceased and receive the cremated remains from the crematory. I authorize the crematory establishment to cremate the human remains of the deceased. The authorizing agent assumes responsibility for the disposition of the cremated remains. We will release the cremated remains to the authorizing agent or his designated agent or ship the cremated remains to the authorizing agent or dispose of the cremated remains not earlier than the 121st day following the date of cremation if the cremated remains have not been claimed by the authorizing agent.

The cremation processing and disposition of the remains of the deceased authorized herein shall be performed in accordance with all governing laws, the rules, regulations and policies of the crematory and funeral home, and the following terms and conditions.

Pacemakers and Implanted Devices

You will declare whether, to your knowledge, the deceased's remains do or do not contain a pacemaker or any other material or implant that may potentially be hazardous or cause damage to the cremation chamber or to the person performing the cremation, and you authorize the removal of any such device prior to cremation.

Cremation Process

It is the policy of the crematory to require that the remains of the deceased be placed in some type of minimum container. If the deceased is not in a container when it reaches the crematory then the minimum container will be furnished and charged to the funeral home. When a casket is used, the crematory is authorized to remove and dispose of handles, ornaments and any other non-combustible items attached to the cremation container prior to cremation. In the event the remains of the deceased are received by the crematory in a casket or container made of non-combustible material, I authorize the remains of the deceased to be removed prior to cremation and placed in a combustible container. We further authorize the crematory to dispose of any non-combustible casket in any lawful manner it deems appropriate.

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. I authorize the crematory to open the cremation chamber during the cremation process and reposition the remains of the deceased to facilitate a complete and thorough cremation.

Certain items, including, but not limited to body prosthesis, dentures, dental bridgework, dental fillings, jewelry, and any other personal articles accompanying the remains of the deceased may be destroyed during the cremation process. I further authorize that if any items, other than the cremated remains of the deceased, are recovered from the cremation chamber, they may be separated from the cremated remains of the deceased and disposed of by the crematory. I hereby authorize the crematory to separate and remove from the cremation chamber all non-combustible materials, including, but not limited to, hinges, latches, nails, jewelry and precious metal and to dispose of such materials.

Following cremation, the cremated remains of the deceased, consisting primarily of bone fragments, will be mechanically pulverized to an unidentifiable consistency prior to placement in an urn or other container. Unless an urn or container suitable for shipment is provided, the crematory will place the cremated remains of the deceased in a container made of plastic and covered with cardboard, which is destructible and will not be held liable for any damages that might occur during shipment. In the event the container or provided urn is insufficient to accommodate all the cremated remains of the deceased, any excess cremated remains will be placed in a secondary container and returned to the funeral home, together with the primary container or urn.

I understand and acknowledge, that even with the exercise of reasonable care and the use of the crematory's best efforts, it is not possible to recover all particles of the cremated remains of the deceased and that some particles may inadvertently become commingled with particles of other cremated remains remaining in the cremation chamber and/or devices utilized to process the cremated remains. I hereby authorize the crematory to dispose of any such residual particles in any lawful manner it deems appropriate.

Indemnification

I agree to indemnify, release and hold the crematory, funeral home, their affiliates, agents, employees and assigns, harmless from any and all loss, damages, liability or causes of action (including attorney's fees and expenses of litigation) in connection with the cremation and disposition of the cremated remains of the deceased, as authorized herein, or my failure to correctly identify the remains of the deceased, disclose the presence of any implanted mechanical or radioactive devices, or take possession of, or make permanent arrangements for, the disposition of such remains.

I warrant that all representations and statements made herein are true and correct and that I have read and understand the provisions contained in this document.

Disclosure / Disclaimer Form

The Federal Trade Commission requires certain disclosures and prohibits misrepresentations in the making of funeral arrangements. This Disclosure / Disclaimer Form is a check list that those we serve are asked to read and sign.

I/We made the arrangements for the funeral and final disposition of the remains of the person to be cremated, do hereby attest to the following:

• I/We was given/shown/viewed pricing online or a General Price List in person.
• I/We were not told that embalming is required by law and were told that the law does not require embalming except in certain special cases. If embalming was provided, this was done with my/our express permission.
• I/We were not told that any law requires embalming for direct cremations, immediate burial, a funeral using a sealed casket, or if refrigeration is available and the funeral is without viewing or visitation and with a closed casket.
• I/We were not told that any law requires a casket for direct cremation or that a casket other than an unfinished wood box is required for direct cremation or for direct disposition.
• I/We were told that state law does not require that purchase of an outer burial container or any of the funeral goods or services I/We selected except as set forth on the "Statement of Funeral Goods and Services Selected." No claims were made to me/us as to the merchandise or other offerings of this funeral firm (embalming, casket, outer burial container) that embalming or the use of any merchandise available from this funeral firm would delay the decomposition of the remains for a long term or indefinite time or would protect the body from graveside substances when such was not the case. No representations or warranties were made to me/us about the protective features of caskets or outer burial containers other than those made by the manufacturer. The only warranties, expressed or implied, granted in connection with goods sold with the funeral service I/we arranged were the expressed written warranties, if any extended by the manufacturers thereof. No other warranties of merchandising fitness for a particular purpose were extended to us.
• I/We were not told that the amount of each of the cash advance items was the cost to the funeral firm. We were told the cost might be different based on volume or cash discounts or other professional/trade customs.
• I/We give permission to KISER UNDERTAKINGS to give out death certificates or information on the deceased or us, at our request to any insurance companies or government agencies that request said death certificates.

Statement of Funeral Goods and Services Selected

Kiser Undertakings  ·  1804 Owen Ct., Ste. 112, Mansfield, TX 76063  ·  (817) 546-0108  ·  TX License #4372

Charges are only for those items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any items, we will explain the reasons in writing below. If you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalming you did not approve if you selected arrangements such as a direct cremation or immediate burial. If we charged for embalming, we will explain why below. In the event you wish to question any aspect of our service you may contact our office. If you have any complaint, which cannot be resolved, you may direct such complaint to the Texas Funeral Service Commission, 1801 Congress Avenue, Suite 11.800, Austin, TX 78701, (512) 936-2474.

The statement you sign lists every good and service you selected with its price, itemizes the cash advance items separately, and shows the total cost. It is built from the order you placed, so the amounts will match what you purchased.

Cash advance items are incurred by our funeral home on your behalf. Certain items may have to be estimated and will be so noted. We charge you for our services in obtaining: the cremation permit and death certificates. The amounts shown for these items may be more than the amounts charged by the issuing agency; the difference is our charge for obtaining them.

Required purchases. The crematory requires a cremation container. A cardboard cremation container and hard plastic temporary urn are included in every package at no additional charge. State law requires a permit before a cremation may be performed; we obtain this permit on your behalf and the fee appears as a cash advance item.

Policies Acknowledged

By signing you acknowledge that you have read and agree to each of the following policies. They form part of the agreement between you and Kiser Undertakings LLC.

Denial of Embalming

I refuse to give permission to embalm the above-named deceased. Texas state law does not require embalming for direct cremation.

Death Certificates

The information you submit to us will be used to complete the death certificate. Death certificates come from Texas Vital Statistics in Austin and usually take at least three to six weeks to arrive in our office after the completion of the cremation. We will contact you when we receive them.

Obituaries

Upon request, we will only assist families with newspaper obituaries that have purchased our Premium cremation package. The cost of the newspaper's publication fee is the responsibility of the family and must be paid prior to publication. A free obituary is included on our website for all families we serve who choose to submit one online.

Cremation Timeline

On average, it takes approximately 7 to 14 business days to complete a cremation. However, it could take longer due to circumstances out of our control. Clients purchasing our Priority and Premium packages will be given priority and receive status updates throughout the entire process. Clients purchasing the Basic package will only be notified when everything is complete. Once we are ready to move forward with the cremation, if there are any authorizations we have not received from the client that necessitates a delay, a $50 daily storage fee will accrue. Should you have plans that require your loved one's ashes, please do not finalize these plans until you have received the ashes.

Cremated Remains & Urns

Ashes must be picked up or scheduled to be shipped no later than 30 days following notification from us that everything is complete. We will only fill jewelry purchased from our firm. We will split or transfer ashes into multiple urns for an additional fee of $49 per urn. If an urn is purchased from our firm, the fee will be waived. Filling of urns purchased elsewhere is by appointment and must be scheduled in advance.

Viewings

A private viewing and/or witness cremation can be arranged at our crematory for those who purchase our Priority or Premium packages. The viewing is by appointment Monday through Friday for an additional fee. Depending on the condition of the remains, this option may not always be available.

Personal Effects & Valuables

Unless we are notified in writing that there are certain personal effects on your loved one (jewelry, ID, valuables, or other items) that you would like to have returned to you, these items will be cremated with the deceased unless previously bagged and separated by the hospital or medical examiner's office.

A complete signed copy of every document above will be emailed to you as soon as you submit the form. Please keep it — insurance companies, banks and attorneys often ask for it later.