Malesich and Shirey Funeral Home & Colorado Crematory

(720) 242-6785

Please fill out the form below. If you have any questions, please do not hesitate to contact us.

I/We, the undersigned, do hereby authorize Malesich and Shirey Funeral Home & Colorado Crematory to cremate the remains of:

Name:

I/We hereby certify that I am the person with the right to control disposition of the last remains of the decedent under state law and that I have the legal right to authorize this cremation and disposal of the cremated remains. I/We understand that due to the nature of the cremation process any VALUABLE METAL, including dental gold, will either be destroyed or will not be recoverable, any personal possessions accordingly have either been removed or may be destroyed. I further agree that I will indemnify and hold harmless the crematory and funeral director, their officers and employees from any liability, cost, expenses or claims resulting from this authorization.

Initial:

I/We request that following cremation, the funeral home return the ashes to:

Name:

Phone:

I/We further state that the deceased has not had a PACEMAKER or RADIATION producing device, nor any other life sustaining device implanted that could be explosive. If such a device exists, I have instructed the funeral director or others to remove it before cremation. I further agree that, in the event of my failure to notify the funeral director or others responsible for the removal of such a device, I/we will be liable for any damages to the crematorium or injury to crematorium personnel.

Initial:

The personal identifying Information provided below will serve as my signature:

Name:

Date:

Relationship to Deceased

Phone:

Address:

City:

State

Zip/Postal Code

Date of Birth:

Last 4 Digits of S.S.N.:

State ID Type:

State

ID Number

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Contact Information

Malesich and Shirey Funeral Home
5400 Ward Road
Building V, Suite 200
Arvada, CO 80002
Phone: (720) 242-6785
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Cremation Authorization

Please fill out the form below. If you have any questions, please do not hesitate to contact us.

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