Arrangement Form (Miami)

We’re Here to Help

We understand this is a difficult time, and our goal is to make this process as simple and supportive as possible. Please select the type of service you wish to arrange and complete the required forms. Once all information has been received, a director will contact you to review next steps and securely process payment.If you have any questions at any point, please don’t hesitate to reach out. We are here to help.
(305) 381-5771 | contact@guscamachojrfh.com

Services We Provide
Direct Cremation at time of Death - $990.00

Includes:
- Professional services of the Funeral Director and staff.
- Transfer of deceased person from location of death within:
  (Miami-Dade & Broward Counties) call for pricing outside of these counties
- Maintaining deceased person in a temperature-controlled unit until cremation can occur.
- Medical Examiners Authorization.
- Securing all Permits and filing of Death Certificate with the State.
- Cremation Process, (for deceased weighing less than 200 Lbs.)
- Please call for pricing on deceased weighing over 201 Lbs.
- Temp Urn TSA approved (Hard Plastic NOT a Cardboard Box)
- Two (2) Certified Death Certificate.
- Notification to Social Security Administration.
Cremation with Viewing - $3,995.00

Includes:
- Professional services of the Funeral Director and staff.
- Transfer of deceased person from location of death within:
  (Miami-Dade & Broward Counties)
- Embalming, Dressing and Preparation of deceased for visitation,
  (required by law for an open casket)
- Use of Funeral Home chapel for visitation for 3 hours.
- Use of a Rental Casket for the visitation.
- Memorial package which includes Basic Register Book, Crucifix and 56 prayer cards.
- Medical Examiners Authorization for Cremation.
- Securing all Permits and filing of Death Certificate with the State.
- Cremation Process, (for deceased weighing less than 200 Lbs.)
  (Please call for pricing on deceased weighing over 201 Lbs.)
- Temp Urn TSA approved (Hard Plastic NOT a Cardboard Box)
- Two (2) Certified Death Certificate.
- Notification to Social Security Administration.
U.S. Veterans, Graveside Burial Service Only (No Viewing) - $2,890.00

Includes:
- Professional services of the Funeral Director and staff.
- Preparing all required legal documents and coordinating with the V.A. Cemetery.
- Transfer of deceased person from location of death, within:
  (Miami-Dade & Broward Counties) call for pricing outside of these counties.
- Dressing, casketing and Preparation of deceased for burial.
- Sanitary Care in lieu of Embalming, embalming in Not Required for in ground burial.
- Basic 20 Gauge Casket (non-sealer) for in ground burial only.
- Use of Hearse to transfer deceased person from Funeral Home to So. Fl. National Cemetery.
- Honor Guard.
- Flag with cardboard case.
- Signed Presidential Letter.
- Securing all Permits and filing of Death Certificate with the State.
- Two (2) Certified Death Certificate.
- Notification to Social Security Administration.
Graveside Burial Service Only(No Viewing) - $2,900.00

Includes:
- Professional services of the Funeral Director and staff.
- Preparing all required legal documents and coordinating with the local cemetery.
- Transfer of deceased person from location of death, within:
  (Miami-Dade & Broward Counties) call for pricing outside of these counties.
- Dressing, casketing and Preparation of deceased for burial.
- Sanitary Care in lieu of Embalming, (embalming in Not Required for in ground burial).
- Basic 20 Gauge Casket (non-sealer) for in ground burial only.
- Use of Hearse to transfer deceased person from Funeral Home to the local cemetery.
- Securing all Permits and filing of Death Certificate with the State.
- Two (2) Certified Death Certificate.
- Notification to Social Security Administration.
Please select the service you wish to move forward with:*

Direct Cremation at time of DeathCremation with ViewingU.S. Veterans, Graveside Burial Service Only (No Viewing)Graveside Burial Service Only(No Viewing)

Release Authorization for Removal of Decedent

NOTICE: THIS IS A LEGAL DOCUMENT. IT CONTAINS IMPORTANT FUNERAL ARRANGEMENT AUTHORIZATION FOR THE DECEDENT. READ THIS DOCUMENT CAREFULLY BEFORE SIGNING.
The undersigned hereby authorize:

CREMATIONS AMERICA, LLC DBA GUS CAMACHO JR. FUNERAL HOME
To Release the Remains of the Deceased*

First NameMiddle NameLast NameSuffix
From Hospital or Location Address*

Hospital or Location Name & Address

Apt No.

CityState / Province

Zip Code
I hereby certify that I am the individual with the nearest degree of relationship to the deceased, as defined under Florida Statute §497.005(43), and that I have the legal authority and responsibility to authorize Cremations America, LLC (d/b/a Gus Camacho, Jr. Funeral Home) to take custody of the deceased and to make the necessary funeral and disposition arrangements.
Name*

First NameMiddle NameLast Name
Relationship*
Signature*

Clear
Date*

MonthDayYear
Date

DEATH CERTIFICATE (DC) REQUISITION
Case No.
Date*

MonthDayYear
Date
Name of Deceased*

First NameMiddle NameLast NameSuffix
Number of DC Copies Ordered
Your arrangements include two (2) Death Certificates. If you would like additional copies, please indicate above.
Family Contact Name*

First NameMiddle NameLast NameSuffix
Cell Number*
Please enter a valid phone number.
Home Number
Please enter a valid phone number.
Special Instruction
Signature of Person Receiving DC's*

Clear

EMBALMING AUTHPRIZATION FORM
I, First Name Last Name , being the decedent's Relationship to Deceased, have requested, Cremations America, LLC ("CA") dba Gus Camacho Jr. Funeral Home to Embalm First Name of deceased Last Name of deceased
Signature of the person with the right to control disposition

Clear
Date signed*

MonthDayYear
Date
Signature of funeral home licensee/representative acquiring written authorization*

Clear
Print name of funeral home licensee/representative acquiring written authorization
I/we (the “Authorized Agent or AA”), the Undersigned, understanding that embalming is not required by law except in certain specials cases, authorizes CREMATIONS AMERICA LLC (“CA”) DBA GUS CAMACHO, JR. FUNERAL HOME, to utilize a licensed facility under the same general ownership and management or use licensed embalmers as agents or independent contractors or a commercial embalming establishment to care for, embalm, and prepare the body of the Deceased. CA accepts the responsibility of revealing, upon request, to the next-of-kin or person responsible for making final disposition arrangements, the name, address, and license number of the facility where embalming occurred and the name and license number of the embalmer and any provisional license or mortuary student who assisted under the embalmer’s direct supervision. AA authorizes and directs CA, including apprentices (provisional licenses), and mortuary students under the direct supervision of a licensed embalmer employed by CA and their employees, independent contractors, and agents to care for, embalm and prepare the body of the decedent. AA acknowledges that this authorization encompasses permission to embalm at CA or at any other facility equipped and licensed for embalming.

AUTHORIZATION FOR CREMATION AND DISPOSITION

This is a legal document that contains important provisions regarding cremation. Please be advised that cremation is an irreversible process. Carefully review this document in its entirety before signing.
I/We, the undersigned, hereby certify, warrant, and represent that I/We have full legal right and authority, as a legally authorized person as defined under Florida Statute §497.005(37), to authorize the cremation, processing, and disposition of the remains of:
Name of Decedent*

First NameMiddle NameLast NameSuffix
Date of Death*

MonthDayYear
Date
Time

Hour Minutes

AM/PM Option
Place of Death*

Street Address or Facility Name

Apt No.

CityState / Province

Zip CodeCountry
I/We hereby request and authorize Cremations America, LLC, doing business as Gus Camacho Jr. Funeral Home, to take custody of the deceased and to make all necessary arrangements for cremation at FCS. I/We further grant the Crematorium full authority to cremate the remains of the deceased and authorize the Crematorium to return the cremated remains to the Direct Disposal Establishment identified herein or as otherwise indicated below. I/We understand and agree that the services and obligations of FCS shall be deemed fully satisfied upon the return of the cremated remains to the possession and custody of Cremations America, LLC, doing business as Gus Camacho Jr. Funeral Home.

Please adhere to the following request:
Is special handling required:

YesNoIf yes, please describe
Is a Witness Cremation requested?

YesNo
Date

MonthDayYear
Date
Time

Hour Minutes

AM/PM Option
Number of Attendees
The cremation, processing, and disposition of the remains of the deceased authorized herein shall be performed in accordance with all applicable federal, state, and local laws, as well as the rules, regulations, and policies of FCS, and subject to the following terms and conditions:
- Cremation Container
  - The remains of the deceased shall be placed in a combustible, leak- resistant, rigid cremation container suitable for cremation.
- Implanted Mechanical or Radioactive Devices
  - Any mechanical or radioactive devices implanted in the remains of the deceased (including, but not limited to, pacemakers) must be removed prior to cremation. In the event that the remains contain such devices, I/We hereby authorize the Crematory, including its agents and employees, to remove any such devices either before or after cremation and to dispose of them in accordance with applicable laws and regulations.
  - Listed below are all known implanted mechanical or radioactive devices that the Crematory is authorized to remove and dispose of as indicated:
A)

B)

C)
- Destruction of Cremation Container
  - Any cremation container in which the remains are placed shall be completely and irreversibly destroyed during the cremation process. I/We authorize the Crematory to open the cremation chamber during the cremation process as necessary to reposition the remains in order to ensure a complete and thorough cremation.
- Personal Effects and Prosthetic Items
  - Articles including, but not limited to, body prostheses, dentures, dental bridgework, jewelry, dental fillings, dental gold caps, metal components of the cremation container, and other personal effects accompanying the remains may be destroyed during the cremation process. I/We further authorize the Crematory to separate and lawfully discard any remaining fragments or materials.
- Processing of Cremated Remains
  - Following cremation, the cremated remains—consisting primarily of bone fragments—shall be collected into a metal container and processed through a pulverizing machine. The processed remains shall then be placed in a plastic bag and enclosed within a temporary cardboard cremation container. I/We hereby authorize the Crematory to pulverize all bone fragments prior to placement in the temporary container.
- Unclaimed Cremated Remains
  - I/We agree that if the cremated remains of the deceased are not claimed within one hundred twenty (120) days from the date of cremation, Cremations America, LLC is authorized and directed to dispose of the unclaimed cremated remains in any lawful manner it deems appropriate.
- Indemnification and Hold Harmless
  - I/We agree to indemnify, release, and hold harmless the Crematory, the Direct Disposal Establishment, and their respective affiliates, agents, employees, and assigns from any and all losses, damages, liabilities, claims, or causes of action—including reasonable attorney’s fees and litigation expenses—arising out of or related to the cremation and disposition of the remains as authorized herein. This includes, but is not limited to, claims resulting from the failure to properly identify the remains of the deceased, disclose the presence of implanted mechanical or radioactive devices, or take possession of or make permanent arrangements for the disposition of the cremated remains.
Release Cremated Remains to:*

First NameMiddle NameLast NameSuffix
Relationship*
I/We warrants that all representations and statements contained in this form are true and correct, and that I/We have read and understand the provisions contained in this document
Signature of Person(s) Authorizing Cremation and Disposition
Signature*

Clear
Name*

First NameMiddle NameLast NameSuffix
Address*
Phone Number*
Please enter a valid phone number.
Relationship*
Signature

Clear
Name

First NameLast NameSuffix
Address
Phone Number
Please enter a valid phone number.
Relationship
I have made the cremation arrangements for the deceased identified above in coordination with the legal next of kin and have received all required signatures for this Authorization for Cremation. I am signing below as a witness.
Funeral Director or Direct Disposer Signature

Clear
Name

First NameLast NameSuffix
Date

MonthDayYear
Date
THIS PAGE MUST BE SIGNED IN THE PRESENCE OF A FUNERAL HOME REPRESENTATIVE, DIRECT DISPOSER, OR CREMATORY STAFF MEMBER, OR IN THE PRESENCE OF A NOTARY PUBLIC.
State of:
County of:
Date:   Date
Before me, a Notary Public in and for said County and State, personally appeared who executed this document and was known by me   Personally    Produced identification
Type of ID:

GENERAL PRICE LIST

Effective Juan 20, 2024
BASIC PROFESSIONAL SERVICES OF FUNERAL DIRECTOR AND STAFF.........$1,700.00 This is the basic charge to each family which we serve for our professional expertise in assisting them. Itincludes, but is not limited to, a proportionate share of the taxes, licenses, utilities and business expensesnecessary to serve the public in a professional manner. Also included in this charge is the consultation with thefamily, clerical and administrative services, preparation and filing of necessary permits, consultation with theclergy, cemetery, crematory or common carrier, planning the funeral, and placement of obituary notices. Therewill be an additional charge for the direction and supervision of each service requested or required. This fee forour basic services and overhead will be added to the total cost of the funeral arrangements you select. (This feeis already included in our charges for direct cremations, immediate burials, and forwarding or receiving ofremains.)

EMBALMING ........................................................................................ $700.00
Embalming is a chemical process which provides temporary preservation of the body and eliminates certain health hazards. A person licensed by this state must complete this procedure. Except in certain special cases, embalming is not required by law. Embalming may be necessary, however, if you select certain funeral
arrangements, such as a funeral with viewing. If you do not want embalming, you usually have the right to choose an arrangement that does not require you to pay for it, such as direct cremation or immediate ground burial, (certain interments in a mausoleum require embalming, please check your cemetery policy)

OTHER CARE OF THE DECEASED:
Washing, Disinfecting and Haircare of unembalmed Remains ...................... $295.00
Dressing, Casketing, Haircare and Cosmetology ........................................ $260.00
Dressing and Casketing Only................................................................... $130.00
Restoration Charge (per hour) .................................................................. $75.00
Refrigeration of unembalmed Remains ..................................................... $425.00
Care and Custody while Sheltering Remains-per day (after initial 2 days) ....... $95.00
Professional Hair Care ............................................................................. $75.00

DIRECTING SERVICES AND USE OF FACILITIES:
Use of Facility for Visitation Services (Includes 4-hour period) ..................... $875.00
Use of Facility for Memorial Services and Services of Funeral Director and Staff in Supervising and Directing Memorial Services in the Funeral Home or in Facility other than the Funeral Home (for 3-hour period) ................................................$725.00
Services of Funeral Director and Staff in Supervising and Directing Graveside Service ........................................................................................................... $650.00
Services of Funeral Director and Staff in Supervising and Directing Graveside Service of Cremated Remains ............................................................................ $650.00
Memorial Services in the Funeral Home when Basic Cremation provided by us ........................................................................................................... $750.00
Memorial Services in the Funeral Home when no other services provided ...... $795.00

AUTOMOTIVE, OTHER EQUIPMENT, OTHER SERVICES AND OTHER CHARGES:
Removal and Transfer of Remains to Funeral Home within 30 miles ............. $550.00
Use of Funeral Coach and Driver for Local Transportation ........................... $500.00
(addt’l) for each stop between Funeral Home & Cemetery) ......................... $275.00
Use of Funeral Van/Coach and Driver for Local Transportation ..................... $250.00
Limousine or Other Passenger Vehicle and Driver (per vehicle charge) .................................................................................................. (Call for Price)
Transportation of Remains to Crematory .................................................. $225.00
Transportation of Remains to/from Airport and/or Transport Facility within 20 miles .......................................................................................................... $300.00
Additional Transportation to Florida National Cemetery (Lake Worth) ........... $500.00

MINIMUM SERVICE OPTIONS:
NOTE: The following packages include only the items listed. You may select additional merchandise and services; however, you may not delete or substitute any items from the package. Cash advance items are additional. Your Funeral Director can explain to you the many options available with immediate burial or immediate cremation. Please feel free to ask any questions you may have.

FORWARDING REMAINS TO ANOTHER FUNERAL HOME ................... From $2,895.00
This charge includes Basic Professional Services of Funeral Director and Staff and Use of Basic Facilities, Obtaining and Filing Legal Documents, Removal of the Deceased from the Place of Death to the Mortuary (within a 30-mile radius), Embalming and/or Sanitary Care of the Remains, Transportation to Airport. Includes Combo Unit or Air Tray.

REMAINS FROM ANOTHER FUNERAL HOME ........................................... $1,995.00
This charge includes Basic Professional Services of Funeral Director and Staff, Administrative Staff, and Transportation from Airport.

IMMEDIATE BURIAL .................................................... From $3,995 to $27,170.00
This charge includes Basic Professional Services of Funeral Director and Staff for Obtaining and Filing Legal Documents, Sanitary Care of the Remains, Removal of the Deceased from the Place of Death to the Mortuary (within a 30-mile radius), and Transportation of the Deceased to the Cemetery for Burial.
Total Immediate Burial with Casket Provided by Purchaser ............... From $2,100.00
Total Immediate Burial with Casket Selected by Purchaser
.................................................................................From $3,995.00 to $27,170

DIRECT CREMATION:
This charge includes Basic Professional Services of Funeral Director and Staff for Obtaining and Filing Legal Documents; Medical Examiners fee; Sanitary Care of the Remains; Use of Facilities and Equipment; Removal of the Deceased from the Place of Death to the Mortuary (within a 30-mile radius); Embalming or Refrigeration; Transportation of the Deceased to the Crematory; and the Cremation Process.
Direct Cremation (w/Alternative Container for deceased less than 200 lbs.) ........................................................................................................ $1,595.00
Direct Cremation (w/Alternative Container for deceased over 201 lbs.) ..................................................................................... $1,795.00 to $2,695.00

CREMATION WITH VIEWING:
This charge includes Basic Professional Services of Funeral Director and Staff for Obtaining and Filing Legal Documents; Medical Examiners fee; Embalming; Use of Facilities and Equipment; Removal of the Deceased from the Place of Death to the Mortuary (within a 30-mile radius); Transportation of the Deceased to the Crematory; and the Cremation Process.
Cremation w/ Viewing (w/Rental Casket for deceased less than 200 lbs.) ........................................................................................................ $3,995.00
Cremation w/ Viewing (w/Rental Casket for deceased over 200 lbs.) .................................................................................. from $4,295 to $6,595.00

MERCHANDISE:
Burial Casket selection range................................... From $1,395.00 to $24,875.00
Cremation Casket selection range .............................. From $2,095.00 to $5,895.00
Cremation Urn Selection Range .................................... From $120.00 to $2,950.00

LIFE REMEMBERED / MEMORIAL PRODUCTS:
Memorial Package selection range ................................... From $125.00 to $550.00
Acknowledgment Cards (per 25) ........................................ From $40.00 to $70.00
Prayer Cards (56 Laminated) .................................................................... $60.00
Memorial Register ........................................................................... From $85.00
Crucifix or Praying Hands Cross ........................................................ From $25.00
Rosary Beads ......................................................................................... $15.00
Keepsakes & Scatter Tubes ....................................................... Starting at $45.00
Witness Cremation ................................................................................ $790.00

OTHER MERCHANDISE AND SUPPLEMENTAL SERVICES:
Packaging and Mailing Fee for Cremated Remains .............................. From $155.00
Flowers ....................................................................... From $125.00 to $900.00
Scattering of Cremated Remains (no family present) ................................. $410.00
Delivery of ashes (within Miami-Dade & Broward County) ........................... $125.00
Placement of Cremated Remains (in urn provided by family) ....................... $45.00
Coordination of select Veterans Services .................................................. $390.00
Preparation of insurance forms and coordination ....................................... $320.00

I certify that I have read and understood the price list of service offered by Cremations America, (dba) Gus Camacho, Jr. Funeral Home.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

We’re Here to Help

Services We Provide

1. DECEDENT'S INFORMATION

2. PLACE OF DEATH

3. DECEDENT'S RESIDENT ADDRESS

3.1 SURVIVING SPOUSE

4. EMPLOYMENT HISTORY (DO NOT ENTER RETIRED)

5. RACE (SELECT ALL THAT APPLY)

6. HISPANIC/HAITIAN ORIGIN

7. HIGHEST LEVEL OF EDUCATION

7.1. ARMED FORCES

8. FATHER'S / PARENT'S NAME PRIOR TO FIRST MARRIAGE

9. MOTHER'S / PARENT'S NAME PRIOR TO FIRST MARRIAGE

10. INFORMANT (LEGAL NEXT OF KIN)

To BE COMPLETED BY FUNERAL DIRECTOR

Release Authorization for Removal of Decedent

DEATH CERTIFICATE (DC) REQUISITION

EMBALMING AUTHPRIZATION FORM

AUTHORIZATION FOR CREMATION AND DISPOSITION

Signature of Person(s) Authorizing Cremation and Disposition

GENERAL PRICE LIST