DECLARATION FOR DISPOSITION OF CREMATED REMAINS
I/We hereby declare (my remains) or (the remains of) in
Name of Person arrangements are for
the possession of , will be cremated by
Name of Funeral Establishment and Telephone Number
and shall be disposed of in the following
Name of Crematory and Telephone Number
manner
(Note 1):
Manner, Location and Other Details of Disposition
Attach additional pages if necessary
Name of person(s) with the legal right to control disposition
(Note 2):
Signed
Date
Person(s) with legal right to control disposition to Self, if pre-arranging
Signed Date
Person(s) with legal right to control disposition
Signed Date
Person(s) with legal right to control disposition
Signed Date
Person(s) with legal right to control disposition
Name of person(s) contracting for cremation services:
Signed Date
Person(s) contracting for cremation services
Signed Lic. # Date
Funeral Director, Employee, or Agent for Funeral Establishment
If a Funeral Director
Note 1: See Health & Safety Code Sections 7054, 7054.6, 7116, 7117 for legal dispositions of cremated remains.
Note 2: See Health & Safety Code Section 7100 for the list of person(s) with the legal right to control disposition of human remains.
IMPORTANT: Business and Professions Code § 7685.2(b) requires Funeral Establishments to complete this form, provided
by the Cemetery and Funeral Bureau, when making arrangements for cremation. Failure to complete this form may result in
disciplinary action by the Bureau. This declaration does not replace the written authorization to cremate required by Health
and Safety Code Sections 7110 and 7111.
NOTICE REGARDING CREMATED REMAINS
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.
If the cremated remains container cannot accommodate all cremated remains of the deceased, 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 Department of Consumer Affairs, Cemetery and Funeral Bureau www.cfb.ca.gov (Rev. 10/2008)
