Claim of Authority of Final Disposition

CLAIM OF AUTHORITY TO CARRY OUT DISPOSITION
PARTIES:
Name of Funeral Home
Representative's Name

First NameLast Name
Decedent's Name

First NameMiddle NameLast Name
2. RELATIONSHIP OF REPRESENTATIVE: The REPRESENTATIVE warrants and represents to the FUNERAL HOME that the relationship between the REPRESENTATIVE and the DECEDENT is as follows: (Check the appropriate box).

Other
3. AUTHORITY OF REPRESENTATIVE: The REPRESENTATIVE warrants and represents to the FUNERAL HOME that: [CHECK ONE BOX BELOW]

The REPRESENTATIVE is the person who, together with other person(s), holds the paramount right to arrange and direct the disposition of the remains of the DECEDENT. REPRESENTATIVE hereby certifies to the FUNERAL HOME that such other person(s) either have been advised of the disposition plans and have not objected to them, or such other person(s) cannot be located by REPRESENTATIVE after a diligent effort to locate them.
4. INDEMNIFICATION: The REPRESENTATIVE acknowledges that the FUNERAL HOME is relying upon the accuracy and truthfulness of the representations and warranties of REPRESENTATIVE made above. The REPRESENTATIVE agrees to indemnify and hold harmless the FUNERAL HOME from any claims or causes of action arising or related in any respect to this claim of authority to carry out the disposition or the FUNERAL HOME’s reliance thereon.
Date

MonthDayYear
Date
Representative's Signature
Should be Empty:

CLAIM OF AUTHORITY TO CARRY OUT DISPOSITION