REGISTER YOUR CREMATION WISHES

CREMATION REGISTRATION AND DECLARATION FORM

for:
(Print Name)

This form is to advise family and friends of my decision to choose cremation for my final disposition. Once this form is filled out correctly, signed and witnessed, it is valid under the laws of Colorado. At my death, this form will be given to my family.

I, , being of sound mind, state that, after my death, I want my family and all others concerned to follow my wishes as stated in this Cremation Declaration Form. This form is meant to replace any information in regards to my final disposition that went before today, (today's date).

The following instructions are what I want done

after my death in regards to my cremation decision:

This is what I want done with my ashes:
(initial)

This is the person (or persons) with whom I have made my wishes known and whom I have entrusted with my cremation decisions:

(Name)

(Relationship)

(Telephone Number)

(Name)

(Relationship)

(Telephone Number)

Check one of the 2 items below:

I do want a memorial serviceI do not want a memorial service

Burial at Ft. Logan National Cemetery

I do wish to have my body viewed before cremationI do not wish to have my body viewed before cremation

If you wish any of the above, please list details, such as memorial packages, urns, obituaries, churches, etc.

Again, I wish to declare that I want cremation as my final disposition and to follow all instructions on this page.


(Your Name)


(Date)

Statement of Witnesses
(2 are necessary) I, the witness, state that the person who signed the "Cremation Registration and Declaration" form is known to me and has signed this form in my presence. He/she appears to be of sound mind and not under duress, fraud or undue influence

(Name)

(Relationship)

(Telephone Number)

(Name)

(Relationship)

(Telephone Number)

VITAL STATISTICS

(The following information is necessary for the death certificate. This information is kept strictly confidential)

Print Name

Address

State

Zip Code

Telephone Number

Date of Birth

Place of Birth

Social Security Number

Check one of the following:

MarriedNever MarriedDivorcedWidowed

Name of Spouse

Wife's Maiden Name

Occupation (before retirement)

Years of Education

Father's Name

Mother's full Maiden Name

Check this box if you would like information on pre-payment plans. (Optional)

This "Cremation Registration and Declaration" Form will be kept on file with All Veterans Cremations & Funerals.
For any changes call 1-800-777-5670

Click here for printable version of this form

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