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One of Florida's Most Respected & Trusted Cremation Service






This is a legal document, please read it carefully before signing. Cremation is irreversible.

I hereby request, authorize, and direct Tri City Diversified Services, LLC (hereinafter “Crematory”) to cremate in accordance with the subject


to its rules and regulations the remains of

whose birth date is

The cremation will occur within 10-14 days of the date of 

death of

, unless the

(hereinafter cremation specialist) whom I have engaged (and whose name is listed above), and by whom Crematory was engaged as a


subcontractor to perform the cremation, having made good faith efforts in that period to obtain the following required authorization, is unable


by the end of that time to obtain same; (1) medical examiner approval for the cremation; or (2) signature of a physician on the death certificate


as to cause of death. If the cremation is delayed due to the delay in receiving the above-identified required authorizations, the cremation will


occur within 48 hours after the receipt of the aforesaid required authorizations.

Terms and conditions of the performance of cremation:


  • I confirm that I have selected traditional flame-based cremation utilizing current 2016 technology and best practices to ensure compliance with all local and federal environmental standards.

  • I direct that the cremated remains be disposed of as follows:

  • List known devices directed to be removed:

  • Would You Like To Upgrade To a Different  Container for Cremation?

  • Special Instructions: 

  • I understand and agree that the remains must be stored before cremation, and then cremated in a leak-resistant, rigid, combustible


         cremation  container. Following cremation, the cremated remains, consisting primarily of bone fragments, will be processed, and


         mechanically pulverized to an unidentifiable consistency. I acknowledge that some particles of the cremated remains may inadvertently     


         become commingled with particles of other cremated remains during the cremation process or pulverization process.


  • I authorize and or Crematory to place the cremated remains in the urn or container provided, described as:

If the urn or container is insufficient to accommodate all of the cremated remains, any excess cremated remains will be placed in a


secondary container and returned to me, or disposed of in any lawful manner at the discretion of or Crematory.


  • Section 497.607(2) Florida Statutes, provides that if, after a period of 120 days from the date of cremation the cremated remains have not been claimed, or Crematory may dispose of the cremated remains by scattering them at sea, placing them in a licensed cemetery scattering garden or pond, placing them in a church columbarium or otherwise as provided by administrative rule.

I hereby indemnify, release and hold harmless Just4cremation and Crematory, their agents, employees, representatives, and assigns from


any and all loss, damage, liability, costs, expenses, or claims resulting from the Authorization, including attorney’s fees and costs of litigation


in connection with the cremation and disposition, including shipping, of the cremated remains.

I am a legally authorized person as defined by 497.005(39) Florida Statutes (set forth below). I authorize the cremation of the remains


identified herein. I attest that I am not aware of any person in my priority class or higher who objects to this authorization. I acknowledge


that no person may make a claim objecting to the cremation of the remains identified herein against or Crematory,


when my Funeral Home and Crematory, act upon the authorization of the legally authorized person executing this authorization.

*Legally authorized person’ means, in the priority listed; (a)The decedent, when written inter-vivos authorizations and directions are


provided by the decedent; (b)The person designated by the decedent as authorized to direct disposition pursuant to Pub.L. No. 109-163,s


564, as listed on the decedent’s United States Department of Defense Record of Emergency Data, DO Form 93, or its successor form if the


decedent died while serving military service as described in 10 U.S.C.s. 1481 (a) (1).(8)in any branch of the United States Armed Forces,


United States Reserve Forces, or National Guard; (c) The surviving spouse, unless the spouse has been arrested for committing against the


deceased an act of domestic violence as defined ins. 741.28 that resulted in or contributed to the death of the deceased; (d) A son or


daughter who is 18 years of age or older, € A parent; (f) A brother or sister who is 18 years of age or older, (g) A grandchild who is 18 years of


age or older, (h) A grandparent, or (i) Any person in the next degree of kinship. In addition, the term may include, if no family member exists


or is available, the guardian of the dead person at the time of death; the personal representative of the deceased; the attorney in fact of the


dead person at the time of death; the health surrogate of the dead person at the time of death; a public health officer, the medical examiner,


county commission, or administrator acting under part II of chapter 406 or other public administrators; a representative of a nursing home


or other health care institution in charge of final disposition; or a friend or other person not listed in this subsection who is willing to assume


the responsibility as the legally authorized person. Where there is a person in any priority class listed in this subsection, the funeral


establishment shall rely upon the authorization of anyone legally authorized person of that class if that person represents that she or he is


not aware of any objection to the cremation of the deceased’s human remains by others in the same class of the person making the


representation or of any person in a higher priority class.

By signing below, I agree that the above information is true and correct. Any errors may lead to additional costs in correcting state documents. 

Thank you for filling out the Authorization for Cremation & Disposition Form.

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