February 2017

Page 2

Cremation Society of Minnesota

ABOUT CREMATION Q. How does the Cremation Society of Minnesota work? A. The Cremation Society is notified immediately

at the time of death. The member’s body is taken to the Society’s crematory. It is held until proper medical authorization and a cremation permit is secured. It is then cremated.

Q. What happens to the ashes after cremation? A. The member’s remains are handled according to their written instructions. They may be picked up by survivors or delivered for a fee.

Q. What is the cost for cremation? A. “Our current cost for our basic direct cremation service is $1,595.00.” It includes removal of the body from the place of death, cremation, filing of necessary papers, and a cardboard container suitable for burial. The charge for non-members, who we also serve, is more.

Q. How do I become a member? A. Fill out the registration form and mail it to our

near-est location. Enclose a one-time membership fee of $15.00 per person. The fee covers setting up and maintaining records. It is not refundable nor an offset to final service costs. We will register you and send you a wallet-sized membership card, and a certificate of registration.

Q. What are the benefits of prepaying for services? A. Prepayment provides two benefits – it removes a

stress from survivors and guarantees that services will be performed at today’s cost.

Q. Where can I learn more? A. You may call or visit any one of our locations, or

visit us at cremationsocietyofmn.com or email us at csminnesota@aol.com

REGISTRATION FORM

Name Address Telephone (

)

INFORMATION REQUIRED ON THE DEATH CERTIFICATE Date of Birth

(will remain confidential)

Place of Birth

Sex ❏ M ❏ F

Race

Hispanic ❏ Yes ❏ No

Father’s Name

Social Security #

Mother’s Name

Marital Status ❏ Married ❏ Never Married ❏ Widowed ❏ Divorced If married, spouse’s full legal name, including maiden Are you a Veteran? ❏ Yes ❏ No

If Yes, enclose a copy of your discharge paper.

AUTHORIZATION FOR CREMATION I, the undersigned, authorize and request the Cremation Society of Minnesota or its assigns to cremate the remains of , and further authorize and request that the following disposition of the cremated remains be made: . I will indemnify and hold harmless the Cremation Society of Minnesota and the crematory from any claims to the contrary including all liability and claims related to the shipment and storage of the cremated remains. Signature

Date

Witness Signature

Date

Address Telephone (

)

Email address

NEXT OF KIN – Please list at least one. Name

Relationship

Address Telephone (

)

PAYMENT PLAN – You are not a member until this form is on file and your registration fee is received. “Our current cost for our basic direct cremation service is $1,595.00.” ❏ I wish to preregister with the Cremation Society of Minnesota

Registration Fee:

❏ I wish to prepay for my Basic Cremation, I understand my pre-payment will be placed in an insurance policy to be used at time of death ❏ I wish to register at this time but not prepay

$15.00 $

Total Paid: $ GA 02/17

PLEASE MAIL FORM TO THE NEAREST CHAPEL LISTED BELOW

Complete Cremation Services PROFESSIONAL · DIGNIFIED · ECONOMICAL

CremationSocietyOfMN.com


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