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Notice: This is a legal document, It contains important provisions concerning cremation. Cremation is irreversible and final. Read this document carefully before signing.
Name of Crematory Establishment: St. Louis Cremation
Name of Funeral Establishment: St. Louis Cremation

I hereby certify that I am the nearest degree of relationship to the deceased and that I have the legal right or am charged to authorize this cremation and the disposal of the cremated remains,. I understand that due to the nature of the cremation process, any personal possessions or valuable materials, such as dental gold or jewelry (as well as any body prosthesis or dental bridgework), that are left with the decedent and are not removed prior to cremation will be destroyed or if not destroyed, will be disposed of by St. Louis Cremation Service. I further agree that I will indemnify and hold harmless the Cremator and Funeral Director, their officers and employees from any liability, costs, expenses or claims resulting from this authorization. I request that following cremation, the funeral home make disposition of the cremated remains as follows: I specifically agree that if the said cremains are left in the custody of St. Louis Cremation for over thirty (30) days, St. Louis Cremation make whatever disposition of the cremains it deems appropriate.

Please verify that all the names, dates, spellings are correct. Currently it takes the state 6 months to make affidavit changes to death certificates.

"Payment agreement. In consideration of services, merchandise and cash expenditures set forth in the Statement of Funeral Goods and Services selected. The undersigned jointly and severally, promise to pay to the order of St. Louis Cremation the sum stated. Said sum is due at the signing of the agreement. This is a cash transaction and payment is due upon these terms. A late charge of 1% per month amounting to 12% per year is applied to the unpaid balance beginning 30 days from the date of this agreement. Any additional services or merchandise ordered or requested after the date of this agreement will be considered part of this agreement and the cost will be reflected on the final statement. In event of default I or we, agree to any and all cost of collection including reasonable attorney fees. I/We the undersigned, acknowledge that the Statement of Funeral Goods and services selected and the disclosure/disclaimer form have been read to me/us, and I /we hereby acknowledge receipt of completed copies of said documents. I/We assume responsibility for payment along with such additional service and items ordered and purchased by me/us, and agree to the terms of payments described above. The liability hereby assumed is in addition to the liability imposed by the law upon the estate and other and shall not constitute a release thereof. DISCLAIMER OF WARRANTIES OUR FUNERAL HOME MAKES NO WARRANTIES OR REPRESENTATIONS CONCERNING THE PRODUCTS SOLD HEREIN. THE ONLY WARRANTIES EXPRESSED OR IMPLIED, GRANTED IN CONNECTION WITH THE PRODUCTS SOLD WITH THE FUNERAL SERVICE ARE THE EXPRESSED WRITTEN WARRANTIES, IF ANY, EXTENDED BY THE MANUFACTURERS THEREOF OUR FUNERAL HOME EXPRESSLY DISCLAIMS ALL WARRANTIES EXPRESS OR IMPLIED RELATING TO ALL SUCH PRODUCTS, INCLUDING, BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FAIRNESS FOR A PARTICULAR PURPOSE."