Usher, Wilma Po
LI
'7 r /) AUTHORIZATION FO ( " TION AND DISPOSITION •
I.the undersigned.certify,warrant and represent that I have full legal rig t and authority,and know of no living person who has a superior priority
right under state law,to authorize the cremation,processing and disposition of the remains of (
{/t jp' Ji-e f ' ("the Deceased"). Date of Death '3 l /.3 ,Time a • �} `fin.,
I further represent that I am not aware of any objection to the cremation of the deceased's human remains by others in the same class as me or of
any person in a higher priority class.
I hereby request and authorize Trahan Family Funeral Home (hereinafter referred to as the"Funeral Home")
to take possession of and make arrangement for the cremation of the remains of the deceased at Pensacola Crematory ("the Crematory"). I
authorize the Crematory to release the remains of the Deceased to the possession and custody of the Funeral Home contained in an approved urn. I
understand that the services and obligations of the Crematory shall be fulfilled when the cremated remains of the deceased are returned to the
possession and custody of the Funeral 1-lome. I hereby authorize the Funeral Home to arrange for the disposition of the deceased as follows:(initial
the appropriate disposition)
Deliver to:
h. Release to(list name and relationship) �'1,:,fr r ( a ii(t'•,t'S ky c I it IC,.t,h r
Ship via IJ.S.P.S. Registered Mail by the Funeral Home (+•Funeral Hone is not rtxpouible for any loss or damaged of cremated remains shipped via 11.S.I'.S.)
Ship to:
Scattering at sea by the Funeral I lome
Other/Special:
The cremation will be completed within 3 days following all required approvals,(Pursuant to Florida Statues 497.607(1).,unless there is an act of
God,a power outage within the area and/or break down of the crematory.
The cremation processing and disposition of the remains of the Deceased authorized herein shall be performed in accordance with all the governing
laws,rules,regulations and policies of the Crematory and the following terms and conditions:
I. The remains of the deceased will not be accepted for cremation unless received by the Crematory in a combustible, leak resistant, rigid
container. The Crematory is authorized to remove and dispose of handles, ornaments and any other non-combustible items attached to the
cremation container prior to cremation.
2. Mechanical or radioactive devices implanted in the remains of the Deceased (such as pacemakers, defibrillators, etc.) may create a hazard
when placed in the cremation chamber. The Crematory will not cremate any human remains which contain any type of implanted mechanical
or radioactive devices. In the event the remains of the Deceased contain such a device, I hereby authorize the Funeral Home or Crematory,
their agents or employees to arrange for such mechanical de%ices to he removed from the re.' ains of the Deceased prior to the cremation,and
dispose of them at their discretion. I certify that the remains of the deceased _DO DO NOT contain any type of implanted
mechanical or radioactive device. Listed below are all the implanted mechanical and radioactive devices which the Cremation Service is
authorized to have removed from the remains of the Deceased prior to cremation and dispose of as indicated:
Device F t Disposition
Device 1 tj ! '" _—__— Disposition
If no instruction for disposition is given for items the crematory will use its own discretion for disposition Initial Here r`'\
3. The container containing the remains of the Deceased will be placed in the cremation chamber and will be totally destroyed by prolonged
exposure to intense heat and direct flame. I authorize the crematory to open the cremation chamber during the cremation process as needed in
order to facilitate a complete and thorough cremation.
4. Certain items, including but not limited to, body prostheses, dentures, dental bridgework, dental fillings, and other personal articles
accompanying the remains may be destroyed during the cremation process. I authorize that if any items,other than the cremated remains of
the Deceased are removed from the cremation chamber,they may be separated from the cremated remains of the Deceased and disposed of by
the crematory.
5. I hereby authorize the Crematory to separate and remove from the cremation chamber all non-combustible materials including but not limited
to hinges,nails.and precious metals and to dispose of such materials.
6. Following cremation, the cremated remains of the deceased, consisting primarily of bone fragments, will be mechanically pulverized to an
unidentifiable consistency prior to placement in the urn or other container.
7. In the event one urn or container is insufficient to accommodate all of the cremated Remains of the Deceased,any excess will be placed in a
secondary container and returned to the Funeral Home together with the primary urn or container.
8. I understand and acknowledge,that even with the exercise of reasonable care and the use of the Crematory's best efforts it is not possible to
recover all particles of the cremated remains of the deceased and that some particles may inadvertently become co-mingled with particles of
other cremated remains remaining in the cremation chamber and/or other devices utilized to process cremated remains. I hereby authorize the
crematory to dispose of any such residue particles in any lawful manner it deems appropriate.
9. Unless I give specific written instructions in this authorization,the cremation,processing and disposition Of the remains of the Deceased will
not be performed in accordance with any religious or ethnic customs.
10. I agree, in the event the cremated remains of the deceased remain unclaimed for a period of 120 days, the Funeral Home is authorized to
dispose of the remains of the Deceased in any manner deemed appropriate.
11. I agree to indemnify,release and hold the Funeral Home,Crematory,their affiliates and assigns,harmless from any and loss,damages,liability
or causes of action(including attorneys' fees and expenses' of litigation) in connection with the cremation and disposition of the cremated
remains of the Deceased,as authorized herein,or my failure to correctly identify the remains of the Deceased,disclose the presence of any
implanted mechanical or radioactive devices,take possession of,or make permanent arrangements for,the disposition of such remains.
12. Except as set forth in this authorization, no warranties expressed or implied are made by the Cremation Service, Crematory or any of their
respective affiliates,agents or employees.
13. I understand that his document does not contain a complete and detailed description of the cremation process.
-Signature of Person Authorizing Cremation and Disposition �^
•
i c i i t �(cliK / ST, Y1
Signature: ,` r "' ` :. /
PLOOP
Lot No. 31 B
Address 101 Boulevard, Glens Falls, N.Y. Section No.
Owner �� Plot Ondawa Ext.
Mr, R. Mrs_ .Tames P1 nnf
Date May Y8, 1971
100Superficial ft. @ $2.00.per sq. ft.
Location Bounded on the North by Vacant, East by Vacant, South by lot of Huntlnaton,
West by Vacant.
Corner Posts
Remarks
Deed No. (and changes) 1181
Payment Record Paid in full May 18, 1971
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Form No. 01
Record of Interments
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Usher
NAME Wilma Usher Age: 65
Lot Owner: Mr. & Mrs James Ploof
Lot# Ondawa Exr 31 B Grave# 1 _B
Case: Urn
Died: 3.7.2 01 3 Interred:6.2.2 3
Funeral Home: Carleton FH
Crematory in Pensacola, FL/TrahanFamily FH
Cemetery: