Required Cremation Documents

Transcription

1 All Faiths Funeral Services 4360 South Congress Avenue, Suite 115 Austin, Texas Phone: (512) / Fax: (512) funeraldirector@allfaithsonline.com website: Required Cremation Documents Please call (512) upon receipt of these documents so that one of our Funeral Directors can give you some instructions on how to complete these forms. Thank you for choosing All Faiths Funeral Services. We sincerely appreciate you allowing us the opportunity to serve you and your family. As a low-cost, privately owned business, we have served the Austin and Central Texas area for over 15 years with quality, dignified funerals and cremations that are affordable for all families. The following forms and documents are included: 1. Vital Statistic Form this form is for the information required to complete the Texas Death Certificate 2. Appointment of Agent this form names a person to handle the disposition of remains in the event of death; this form must be signed, prior to the death, and in front of a notary public or attorney. 3. Cremation Authorization Form this form must be completed and signed in front of a Notary Public; although Texas law states only one surviving child/other next of kin is necessary to sign, we require all of the legal next of kin s signatures. 3. Supplemental Form for Cremation Authorization addendum for Cremation Authorization Form 4. Authorization to Embalm at Funeral Home or Other Establishment this form must be signed at the bottom (highlighted area) to say that you are refusing embalming 5. Travis County Medical Examiner Release Form this form must be completed 6. General Price List this document is for your review and retention. FAX ALL COMPLETED FORMS TO (512) OR YOU MAY SCAN AND THEM TO funeraldirector@allfaithsonline.com WE WILL FOLLOW UP WITH YOU VIA TELEPHONE.

2 VITAL STATISTIC FORM NOTE: PLEASE COMPLETE THIS FORM IN ITS ENTIRETY. DO NOT OMIT OR DELETE ANY INFORMATION. YOUR FAILURE TO COMPLETE THIS INFORMATION WILL DELAY THE DEATH CERTIFICATE PROCESS AND DELAY THE CREMATION. DECEASED INFORMATION: First Name: Middle: Last: If Female, Maiden Name: Age: Sex: Date of Birth: Birthplace: Social Security: Veteran? YES NO Branch: (If Veteran, please fax us DD214 or Discharge) Marital Status: (Circle One) MARRIED WIDOWED DIVORCED NEVER MARRIED Surviving Spouse (If female, list maiden name): Deceased Residence: City: County: State: Zip: Inside City Limits?: YES NO Deceased Father s Name: Deceased Mother s Name (List Maiden Name): Deceased Occupation (Do Not List Retired): Industry or Type of Business: Deceased Level of Education: (Select One): Less Than 8 th Grade 9 th 12 th Grade (No Diploma) HS Diploma or GED Some College, No Degree Bachelors Masters Doctorate Race: Of Hispanic Origin?: YES NO Ever serve as a Peace Officer in Texas?: YES NO Family Contact: Relationship: Address: City: State: Zip: Phone: ( ) Cell: ( )

3 APPOINTMENT OF AGENT TO CONTROL DISPOSITION OF REMAINS I,, (your name and address) being of sound mind, willfully and voluntarily make known my desire that, upon my death, the disposition of my remains shall be controlled by (name of agent) in accordance with Section of the Health and Safety Code and, with respect to that subject only, I hereby appoint such person as my agent (attorney-in-fact). All decisions made by my agent with respect to the disposition of my remains shall be binding. SPECIAL DIRECTIONS: Set forth below are any special directions limiting the power granted to my agent: AGENT: Name: Address: Telephone Number: Acceptance of Appointment: Date of Signature: (signature of agent) SUCCESSORS: If my agent dies, becomes legally disabled, resigns, or refuses to act, I hereby appoint the following persons (each to act alone and successively, in the order named) to serve as my agent (attorney-in-fact) to control the disposition of my remains as authorized by this document: 1. First Successor Name: Address: Telephone Number: Acceptance of Appointment: Date of Signature: (signature of first successor) 2. Second Successor Name: Address: Telephone Number: Acceptance of Appointment: Date of Signature: (signature of second successor) DURATION: This appointment becomes effective upon my death. PRIOR APPOINTMENTS REVOKED: I hereby revoke any prior appointment of any person to control the disposition of my remains.

4 RELIANCE: I hereby agree that any cemetery organization, business operating a crematory or columbarium or both, funeral director or embalmer, or funeral establishment who receives a copy of this document may act under it. Any modification or revocation of this document is not effective as to any such party until that party receives actual notice of the modification or revocation. No such party shall be liable because of reliance on a copy of this document. ASSUMPTION: THE AGENT, AND EACH SUCCESSOR AGENT, BY ACCEPTING THIS APPOINTMENT, ASSUMES THE OBLIGATIONS PROVIDED IN, AND IS BOUND BY THE PROVISIONS OF, SECTION OF THE HEALTH AND SAFETY CODE. Signed this day of, 20. (your signature) State of County of This document was acknowledged before me on (date) by (name of principal). (signature of Notary Public) (Seal, if any, of notary) (printed name) My commission expires:

5 DEATH CERTIFICATE COPIES Cost is $21 for the first copy and $4 for each additional copy Please order copies of the Death Certificate. CREMATION PROCESS The following must occur before the cremation process can take place under normal circumstances: 1. The DEATH CERTIFICATE must be completed and signed by the certifier (Doctor, Medical Examiner, or Justice of the Peace), which has up to 5 days to return the certificate to the funeral home once delivered. 2. An AUTHORITY TO CREMATE must be issued by the Medical Examiner or Justice of the Peace in the jurisdiction of death. 3. A properly completed, signed DEATH CERTIFICATE must be filed with the local registrar. 4. A BURIAL TRANSIT PERMIT must be obtained from the local registrar. Once all documents are in the possession of the funeral home, the cremation can be arranged. The funeral home will make every effort to complete the cremation arrangements as timely as possible. The average time from the date that ALL of the requested documents have been received by the funeral director to the completion of cremation is approximately 5 to 7 business days. However, the funeral home is not responsible for circumstances beyond our ability to control, such as: crematory schedule, doctor s/certifier s availability, holidays, weather, etc. I acknowledge that I have read the above information. I understand that cremation cannot occur until all documents and permits are secured as stipulated by Texas law. Signature: (Legal Next of Kin) Date:

6 SIGNING THE CREMATION AUTHORIZATION FORM Texas Health and Safety Code Section (a) states that unless the decedent has left directions in writing for the disposition of the decedent s remains, [ ] the following persons, in the priority listed, have the right to control the disposition, including cremation, of the decedent s remains : 1. Appointed Agent named in an approved notarized document 2. The decedent s surviving spouse 3. Any one of the decedent s surviving adult children 4. Either one of the decedent s surviving parents 5. Any one of the decedent s surviving adult siblings 6. Any adult person in the next degree of kinship in the order named by law to inherit the estate of the decedent. PLEASE COMPLETE THE FOLLOWING SECTION COMPLETELY I certify that the Deceased had the following survivors who may, by law and in the order given as stated in the Texas Health and Safety Code Section , control disposition. (Note: The person by the first YES answer is the person who must sign the Cremation Authorization Form) *Appointed Agent: Spouse: Adult Children: Yes No Name: Yes No Name: Yes No How Many? Names: Parents: Adult Siblings: Yes No Names: Yes No Names: Other Names and Relationships: * The Appointed Agent must be named in an approved document written and signed by the deceased, signed by the Agent, and approved by a Notary Public.

7 Onion Creek Memorial Park Inc. Same Ownership as All Faiths Funeral Services AUTHORIZATION FOR CREMATION AND DISPOSITION NOTICE: THIS IS A LEGAL DOCUMENT. IT CONTAINS IMPORTANT PROVISIONS CONCERNING CREMATION. CREMATION IS IRREVERSIBLE AND FINAL. READ THIS DOCUMENT CAREFULLY BEFORE SIGNING. I/We the undersigned, having been given ample time to review the remains, do hereby positively identify the same as that of the body of (hereinafter referred to as the Deceased) who died at (Time), County and State of on the day of, 20 and authorize Onion Creek Memorial Park, Inc. (hereinafter referred to as the Crematory) to arrange cremation of said remains, and certify, warrant and represent that I/We have the full legal right and authority to authorize the cremation, processing and disposition of the remains of the above named Deceased. ( I/WE ARE NOT AWARE OF ANY PERSON WITH A SUPERIOR OR EQUAL PRIORITY RIGHT) OR ( PLEASE REFER TO SUPPLEMENTAL FORM, ITEM A) I/We hereby request and authorize All Faiths Funeral Home (hereinafter referred to as the Funeral Home ) to take possession of and make arrangements for the remains of the Deceased at Onion Creek Memorial Park, Inc. I/We understand that the services and obligations of the Crematory shall be fulfilled when the instructions for the disposition of the cremated remains have been fulfilled. I/We hereby authorize the Funeral Home/Crematory to arrange for the disposition of the cremated remains of the Deceased as follows: Description of urn or container selected: Suitable for shipping: Yes No Deliver to Cremated remains will be released only to the above designated family member(s) or an authorized family representative Release to Relationship Address Phone No. Ship via To: Name Address: Other The cremation, processing and disposition of the remains of the Deceased authorized herein shall be performed in accordance with all governing laws, the rules, regulations and policies of the Crematory and Funeral Home, and the following terms and conditions: 1. The remains of the Deceased will not be accepted for cremation unless received by the Crematory in a combustible, leak resistant, rigid cremation 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, 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 device. In the event the remains of the Deceased contains such a device, I/We hereby authorize the Funeral Home, its agents and employees, to remove any such mechanical devices from the remains of the Deceased prior to cremation, and dispose of such items at its discretion. I/WE HEREBY CERTIFY THAT THE REMAINS OF THE DECEASED DO DO NOT CONTAIN ANY TYPE OF IMPLANTED MECHANICAL OR RADIOACTIVE DEVICE. Please initial one Listed below are all implanted mechanical and radioactive devices which the Funeral Home is authorized to remove from the remains of the Deceased prior to cremation, and dispose of as indicated: Description of Implanted Device Disposition If no instruction for disposition is given, such items may be disposed of at the discretion of the Funeral Home and/or Crematory. Page 1 of 3

8 3. The cremation container containing the remains of the Deceased will be placed in the cremation chamber and will be totally and irreversibly destroyed by prolonged exposure to intense heat and direct flame. I/We authorize the Crematory to open the cremation chamber during the cremation process and reposition the remains of the Deceased in order to facilitate a complete and thorough cremation. 4. Certain items, including, but not limited to, body prostheses, dentures, dental bridgework, dental fillings, jewelry, and other personal articles accompanying the remains of the Deceased, may be destroyed during the cremation process. I/We further authorize that if any items, other than the cremated remains of the Deceased, are recovered from the cremation chamber, they may be separated from the cremated remains of the Deceased and disposed of by the Crematory. 5. I/We hereby authorize the Crematory to separate and remove from the cremation chamber all noncombustible materials, including, but not limited to, hinges, latches, nails, jewelry 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 an urn or other container. 7. Unless an urn or container suitable for shipment is purchased, the Crematory will place the cremated remains of the Deceased in a temporary container which would be suitable for shipment. All cremated remains shipped within the United States will be shipped via U.S. Registered Mail, unless otherwise instructed. 8. In the event the urn or container is insufficient to accommodate all of the cremated remains of the Deceased, any excess cremated remains will be placed in a secondary container and will accompany the primary urn or temporary container when released. 9. I/We 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 commingled with particles of other cremated remains remaining in the cremation chamber and/or other devices utilized to process the cremated remains. I/We hereby authorize the Crematory to dispose of any such residual particles in any lawful manner it deems appropriate. 10. Unless I/We 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 particular religious or ethnic customs. 11. In the event the cremated remains of the Deceased remain unclaimed for a period of 30 days, the Funeral Home and/or Crematory shall give written notice to me/us by certified mail at the address(es) indicated below. I/We agree that in the event the cremated remains of the Deceased remain unclaimed for a period of 120 days after the date of such written notification is mailed, the Funeral Home and/or Crematory is authorized and directed to dispose of the unclaimed cremated remains of the Deceased in any lawful manner it may deem appropriate. 12. I/We agree to indemnify, release and hold the Crematory, Funeral Home, their affiliated agents, employees and assigns harmless from any and all 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/our failure to correctly identify the remains of the Deceased, disclose the presence of any implanted mechanical or radioactive devised, or take possession of, or make permanent arrangements for the disposition of such remains. 13. Except as set forth in this Authorization, no warranties, expressed or implied, are made by the Funeral Home, Crematory or any of their respective affiliates, agents or employees. 14. I/We understand that this document does not contain a complete and detailed description of every aspect of the cremation process. I/We acknowledge receiving, from the Funeral Home, a copy of the booklet entitled Cremation Facts containing additional explanatory information about the cremation process. Page 2 of 3

9 SIGNATURE OF PERSON(S) AUTHORIZING CREMATION AND DISPOSITION I/We warrant that all representations and statements made herein are true and correct, and that I/We have read and understand the provisions contained in this document, and that I/We have received the booklet entitled Cremation Facts. Signature Print Name Relationship to Deceased Address Tel. No. ( Street City State Zip ) Signature Print Name Relationship to Deceased Address Tel. No. ( Street City State Zip ) WITNESS: Print Name DATE:, 20 I hereby acknowledge that all signatures are in compliance with Section of the Health and Safety Code. THIS FORM MUST BE SIGNED IN FRONT OF A FUNERAL DIRECTOR OR NOTARY PUBLIC. Signed this day of, 20 STATE OF TEXAS COUNTY OF This document was acknowledged before me on by. (Signature of Notary Public) (Printed Name of Notary Public) SEAL: My Commission Expires: Page 3 of 3

10 Onion Creek Memorial Park Inc. Same Ownership as All Faiths Funeral Services SUPPLEMENTAL FORM to AUTHORIZATION for CREMATION Funeral Home All Faiths Funeral Services Deceased A. ( ) 1. I/we acknowledge that, relationship, has an equal priority right to authorize cremation. However, we have made all reasonable efforts but failed to contact this person and believe that this person would not object to the cremation of. I/we also agree to indemnify and hold harmless the funeral establishment and crematory establishment for any liability arising from performing the cremation without this person s authorization. ( ) 2. Please refer to the attached Appointment of Agent to Control Disposition of Remains as outlined in accordance with Section of the Health and Safety Code. ( ) 3. I hereby acknowledge that there is no surviving next of kin. I also agree, at my sole expense, to defend, hold harmless and indemnify the funeral establishment and Onion Creek Memorial Park Crematory for any liability suit, cause of action, cost or expense resulting in any way from your reliance on or performance consistent with the directions, declarations, representatives, and agreement to cremate. B. Instructions for the disposition of the following items of value: C. The following services have been arranged: D. Please outline your plans for final disposition (if known). Signature: Print Name Date

11 AUTHORIZATION TO EMBALM AT FUNERAL ESTABLISHMENT OR OTHER LOCATION Name of Licensed Funeral Establishment All Faiths Funeral Services Name of Deceased Date of Death The undersigned, understanding that embalming is not required by law except in certain special cases, authorizes the funeral establishment to utilize a licensed facility under the same general ownership and management or use licensed embalmers as agents or independent contractors or a commercial embalming establishment to care for, embalm, and prepare the body of the deceased. The funeral establishment accepts the responsibility of revealing, upon request, to the next-of-kin or person responsible for making final disposition arrangements, the name, address, and license number of the facility where embalming occurred and the name and license number of the embalmer and any provisional licensee or mortuary student who assisted under the embalmer s direct supervision. The undersigned authorizes and directs the funeral establishment, including apprentices (provisional licensees), and mortuary students under the direct supervision of a licensed embalmer employed by the funeral establishment, and the funeral establishment s employees, independent contractors, and agents to care for, embalm and prepare the body of the decedent. The undersigned acknowledges that this authorization encompasses permission to embalm at the funeral establishment or at another facility equipped for embalming, including a school or college of mortuary science. Date Signed Signature of next-of-kin or Person Responsible for making arrangements for final disposition NOTE: Mortuary Students may only participate in embalming if permission is in writing and in the possession of the Licensed Embalmer at the time of the procedure. If Authorization for embalming is oral, complete the following: Location of embalming disclosure was discussed with next-of-kin or person responsible for making arrangements. Authorization to embalm received from Relationship to Deceased Time a.m. or p.m. Date Received by If no authorization can be obtained, complete the following: I hereby acknowledge that has made a reasonable effort over a Name of Establishment period of at least three hours to obtain authorization to embalm the deceased. I take full responsibility for performing embalming without permission. Times contact with family attempted: Signature and License # of Embalmer The undersigned, who represents the deceased, hereby declares that having the legal authority to do so, refuses to give permission to embalm the above-named deceased individual. Signature Date

12 If your loved one is currently in the care of the Medical Examiner, please fill out the following form: All Faiths Funeral Services 4360 S. Congress Ave., Ste. 115 Austin Texas

13 All Faiths Funeral Services Offering Basic Cremations & Burials 4360 S. Congress, Ste. 115 Austin, Texas Fax: Lic. # General Price List Casket Price List and Outer Burial Container Price List These prices are effective as of January 21, 2015 and are subject to change without notice. The following price list meets the necessary requirements of funeral pricing required by the Federal Trade Commission. While there are very specific language and disclosures required from the FTC, we have included additional information in more understandable terms. It is our hope that we help the consumer become educated and not intimidated.

14 All Faiths Funeral Services PAYMENT POLICY To lose someone you love is a devastating experience. It is frequently traumatic and can seriously impact judgment. We believe in the importance of the recognition and meaningful celebration of a life that has been lived, and will assist in arranging an appropriate service to meet your individual needs. It is also important to be realistic in respect to funeral expenditures. We do not want a family to spend more than they should, nor less than they would like. It is important that arrangements are kept within the family s wishes and budget. Provisions for payment are due at the time of arrangements. All prices listed within this General Price List are cash prices. To avoid any possibility of misunderstanding, and for your convenience, we accept the following methods of payment that are approved and verified. Cash Check - Debit Card Visa MasterCard Discover American Express Insurance Assignment of a verifiable policy will be subject to an insurance processing fee of a minimum of $65.00 or 4.75% of the assigned amount, whichever is greater. Due to our low prices, this will cover the minimum processing fee. Advance payment by forwarding or receiving funeral home Pre-Arrangement For obituaries, family is responsible for all charges for the placement of a paid obituary with a newspaper, as charges may vary per newspaper. Funeral Home is not responsible for any cost or charges for the obituary. These prices are effective as of January 21, 2015 and are subject to change without notice. By signing below, the undersigned acknowledges receipt of the Payment Policy and understands the financial obligation and responsibility for all charges and costs related to the funeral service. Undersigned Purchaser Date Undersigned Purchaser Date I have given the Payment Policy to the family. Funeral Director Date

15 All Faiths Funeral Services GENERAL PRICE LIST For Families Desiring an Itemized Selection of Services 4360 S. Congress, Ste. 115 Austin, Texas (512) (512) FAX Lic. #3086 These prices are effective as of: January 21, 2015 But are subject to change without notice. The Federal Trade Commission Trade Regulation Rules for Funeral Industry Practices and the Texas Funeral Service Commission require certain disclosures and prohibit misrepresentations. This form complies with all known requirements of the aforementioned agencies. The goods and services shown below are those we can provide to our customers. You may choose only the items you desire. However, any funeral arrangements you select will include a charge for our basic services and overhead. If legal or other requirements mean you must buy any items you did not specifically ask for, we will explain the reason in writing on the statement we provide describing the funeral goods and services you selected. You may choose only the items you desire. You will be charged for the items you use. If you have to pay for any items you did not specifically ask for, we will explain the reason in writing on the memorandum of the agreement. Please note that there may be charges for items such as cemetery fees, flowers, and newspaper notices. (S.B th Legislature) The descriptions Gasketed and Non-Gasketed are the manufacturers. Although certain caskets and vaults offered for sale by the funeral provider may be of better quality construction and comprised of more durable material than another, neither the Funeral Provider nor any of its employees represents or implies that any casket or vault will be water tight or will provide long term preservation of human remains.

16 ITEMIZED SERVICE SELECTIONS Basic Professional Services of Funeral Director and Staff $ This is the basic charge to each family which we serve, for our professional expertise in assisting them. It includes, but is not limited to, an appropriate share of the taxes, licenses, utilities and business expenses necessary to serve the public in a professional manner. Also included in this charge is the consultation with the family, clerical and administrative services, local preparation and filing of necessary permits, sheltering of remains, consultation with the clergy, cemetery, crematory, common carrier, assistance with insurance papers, planning the funeral or memorial services, and consulting and submitting of one courtesy obituary notice (free death notice) in a local paper. There will be an additional charge for the direction and supervision of each service requested or required. This fee for our basic services and overhead will be added to the total cost of the funeral arrangements you select. (This fee is already included in our charges for direct cremations, immediate burials, and forwarding or receiving remains.) Embalming $ Embalming is a chemical process which provides temporary preservation of the body and eliminates certain health hazards. A person licensed by this state must complete this procedure. Except in certain special cases, embalming is not required by law. Embalming may be necessary, however, if you select certain funeral arrangements, such as funeral with a viewing. If you do not want embalming, you usually have the right to choose an arrangement that does not require you to pay for it, such as direct cremation or immediate burial. Other Preparation of Deceased: Washing and Disinfecting of Unembalmed Remains $ Dressing, Casketing and Cosmetology $ Hair Stylist $ Post Autopsy Care $ Post Organ Donation Charge $ Refrigeration Services (per day) $ Refrigeration charges will only be incurred in the event final disposition is delayed by choice of family, medical or legal authority. Insurance Assignment of a verifiable policy will be subject to an insurance processing fee of a minimum of $65.00 or 4.75% of the assigned amount, whichever is greater. Please note that additional charges may be incurred for deceased weighing 300 pounds or more.

17 USE OF FACILITIES AND STAFF Use of Facilities and Staff for Visitation at our facility $ Our services include coordinating and supervision of visitation at our facility, setup and use of visitation room, and staff in attendance for visitation, up to 4 hours maximum. Seating capacity for 15 persons. Each additional day of viewing (4 hours maximum per day) $ Additional Visitation after 4 hour maximum limit at our facility or other facility (per hour) $ Use of Staff and Equipment for Visitation, Wake or Rosary at Other Facility $ Our services include coordinating and supervision of visitation at other facility, setup at other facility, and staff in attendance for visitation, up to 4 hours maximum. Use of facilities for limited visitation or ID viewing $ Our services include set up and use of small viewing room for limited visitation or ID viewing for immediate family only, up to one-half hour maximum. Use of Facility and Staff for Funeral Service in our Chapel $ Our services include coordinating and supervision of the funeral service, setup and use of chapel, and staff in attendance for funeral service. Seating capacity for 15 persons. Use of Staff and Equipment for Funeral Service at Other Facility $ Our services include coordinating and supervision of the funeral service at other facility, setup, and staff in attendance for funeral service. Use of Staff and Equipment for Graveside Service at Cemetery $ Our services include transportation to cemetery, supervision of graveside service, and staff in attendance for service, up to 2 hours maximum. Use of Facility and Staff for Memorial Service in our Chapel $ This charge is for use of our chapel when funeral home has no involvement with care and disposition of remains. Our services include the use of our chapel for a memorial service without remains present, coordinating and supervising of the memorial service, and staff in attendance for memorial service. Use of Off Site Facility (Seating for 110) for Funeral or Memorial Service $ Additional charge for use of Facilities and Staff on Sundays and Holidays $ Overnight Use of Facilities for Viewing or Service $ The family is responsible for payment of a licensed security officer. Overnight fee for Funeral Director or Staff (Traveling more than 175 miles for service) $ Special Offering: Twilight Service $ This service includes a standard visitation with funeral service, up to 4 hours maximum after 5:30 PM Monday through Friday. Includes graveside service the next day, meeting at cemetery, with no escorts.

18 AUTOMOTIVE EQUIPMENT AND TRANSPORTATION Standard Removal and Transfer of Remains to Funeral Home (35 mile radius) $ Deceased weighing 300 pounds or more will have an additional charge for additional personnel to assist in the removal. Additional Personnel for Removal (only charged due to weight and safety requirements) $ Lead Vehicle / Minister Car $ Funeral Vehicle (Suburban) (35 mile radius) $ Funeral Coach (Hearse) (35 mile radius) $ Limousine (Per vehicle) (35 mile radius) $ Additional limousines are available. Rates will be quoted by limousine service and will require a 3 hour minimum. Additional hours will be billed for any overtime charges and due immediately by family upon receipt of limousine service statement. Credit card deposit must be held for use of independent limousine service companies. Transfer to or from Airport / Crematory $ Transfer of deceased from Funeral Home to place of autopsy and return to Funeral Home $ Additional Transportation charges per vehicle (One way / per mile) $ 2.95 ABBREVIATED SERVICE OPTIONS Forwarding Remains to Another Funeral Home $ This charge includes standard removal of remains, minimum services of staff, necessary authorization, embalming, and local transportation (excluding shipping charge and shipping container; mileage charges will be added for overland transportation beyond 35 mile radius). This charge does not include use of facilities and staff for visitation or ceremonies. Receiving Remains from Another Funeral Home $ This charge includes minimum services of staff and transportation from airport. This charge does not include visitation or ceremonies. Immediate Burial* (See page 8 for special package pricing) This service includes the basic services of the funeral director and staff; administrative staff for obtaining legal documents; standard removal of the deceased from the place of death to the Funeral Home within a 35 mile radius; sanitary care of the remains and transportation of the deceased to the cemetery for burial in funeral coach or funeral vehicle. Burial will be performed at Funeral Home s convenience. This service does not include: embalming or other preparation of the remains; viewing or other use of facilities for viewing or funeral service; graveside service; merchandise such as casket, outer burial container, clothing, sundries; or any cash advance items. Total Immediate Burial with Casket provided by Purchaser $ Total Immediate Burial with minimum standard* casket from Funeral Home $2,530 to $22,625.00

19 BASIC (DIRECT) CREMATION Basic (Direct) Cremation No services or Viewing of remains $ Online $ In Office This service includes: the service of the funeral director, staff and administrative staff; obtaining legal documents, and other paperwork necessary to complete the arrangements at the funeral home; standard removal of the deceased from the place of death to the Funeral Home within a 35 mile radius; transfer of body to crematory; *standard refrigeration services are included; *standard crematory fee; return of cremated remains to Funeral Home. This service does not include: viewing; merchandise such as casket or cremation urn; outer burial container, clothing, sundries, any cash advance items, mailing of cremated remains or faxing documents. Death certificates are to be picked up at Funeral Home. If you want to arrange a direct cremation, you can use an alternative container. Alternative containers encase the body and can be made of materials like fiberboard or composition materials (with or without an outside covering). The containers we provide are a fiberboard container. Note: The following must occur before the cremation process can take place under normal circumstances: The Death Certificate must be completed and signed by the certifier (Doctor, Medical Examiner, or Justice of the Peace), which has up to 5 days to return the certificate to funeral home once delivered. An Authority to Cremate must be issued by the medical examiner or the Justice of the Peace in the jurisdiction of the death. A properly completed, signed Death Certificate must be filed with the local registrar. A Burial Transit Permit must be obtained from the local registrar. ** Refrigeration charges will only be incurred in the event final disposition is delayed by choice of family, medical or legal authority. **Crematory fees included in any pricing are a standard crematory fee of Onion Creek Memorial Park and Crematory. Remains weighing in excess of 300 lbs. will be subject to additional charges in addition to those already mentioned and are subject to the discretion of the crematory. Committal to Flame (accompanied cremation) add to price $ Basic (Direct) Cremation with container provided by the purchaser with *standard crematory fee $ Basic (Direct) Cremation with Alternative Container provided by Funeral Home $ with *standard crematory fee

20 SPECIAL DISCOUNTED PACKAGES (Applies to At Need Services Only) Simplicity Funeral Service in South Austin Chapel $ This service occurs Monday through Friday, 9:00 A.M. to 3:00 P.M. excluding legal holidays, with a 1 hour maximum limit visitation, on the same day, prior to service time. This service includes: the service of the funeral director and staff, administrative staff for coordinating and directing the service; obtaining legal documents, and other paperwork necessary to complete the arrangements; standard removal of the deceased from the place of death to the Funeral home within a 35 mile radius; embalming and/or sanitary care of the remains; other preparation of the remains, dressing, casketing, cosmetics; use of facilities for funeral service in our chapel; funeral coach; lead vehicle; Graveside Service; minimum standard* metal casket (oversize caskets are available at additional cost). No changes to this package are allowed. This service does not include: merchandise such as an outer burial container, clothing, sundries or any cash advance items. Casket upgrades are available by paying the difference of the listed prices on our price list. Twilight Funeral Service in South Austin Chapel $ This service occurs Monday through Friday, after 5:30 PM, excluding legal holidays, with a 4 hour maximum limit visitation, on the same day, prior to service time. This service includes: the service of the funeral director and staff, administrative staff for coordinating and directing the service; obtaining legal documents, and other paperwork necessary to complete the arrangements; standard removal of the deceased from the place of death to the Funeral home within a 35 mile radius; embalming and/or sanitary care of the remains; other preparation of the remains, dressing, casketing, cosmetics; use of facilities for visitation in our chapel, up to 4 hours maximum; use of facilities for funeral service in our chapel; funeral coach; lead vehicle; Graveside Service following the next day; minimum standard* metal casket (oversize caskets are available at additional cost). No changes to this package are allowed. This service does not include: merchandise such as an outer burial container, clothing, sundries or any cash advance items. Casket upgrades are available by paying the difference of the listed prices on our price list. Special Immediate Burial Package with Apollo standard* metal casket See Page 6* $ This package includes all services of the Immediate Burial (see page 6) with the Apollo standard* metal casket. (Oversize caskets are available at additional cost.) Casket upgrades are available by paying the difference of the listed prices on our price list. Mexico Ship-Out Package $ This package includes use of facilities and staff for funeral service in our chapel, forwarding remains and the Apollo standard* metal casket. (Oversize caskets are available at additional cost.) Casket upgrades are available by paying the difference of the listed prices on our price list.

21 MERCHANDISE We offer many different styles and prices of caskets and alternative containers from which to select. Since many caskets that appear similar in appearance may differ greatly in quality and construction, we offer the following in order to assist you in making an informed decision. Gasketed These caskets are designed by the manufacturer to resist the entrance of air, water and other outside elements. They may be constructed of varying gauges of steel, copper and bronze. Non-Gasketed These caskets are not designed by the manufacturer to resist the entrance of air, water and other outside elements. They may be constructed of metal, hardwood or wood products with fabric. A complete list of caskets offered by this firm will be provided upon request. CASKETS Casket Selection Ranges From $19, to $ A complete price list will be provided at the Funeral Home *Standard width caskets may not accommodate the weight of some human remains. Additional charges will apply should an oversize casket be required for the human remains. OUTER BURIAL CONTAINERS Outer Burial Container Selection Ranges From $ to $ A complete price list will be provided at the Funeral Home Disclaimer of Warranty: The only warranty on the casket or any other merchandise sold in connection with this service is the express written warranty, if any, granted by the manufacturer. This funeral home makes no warranty, expressed or implied, including an implied warranty of merchantability and an implied warranty of fitness for a particular purpose, with respect to the casket and/or outer burial container. GENERAL POLICIES Disinterments Our minimum professional fee is $ This includes the necessary family conferences, coordinating with the cemeteries, grave service companies, arranging for transportation and obtaining the necessary permits and authorizations. All grave service charges and transportation will be handled as a cash advance (you will be charged only what we are charged). We reserve the right to make additional charges for the professional services which require more of our time. Unembalmed Bodies Texas statutes provide that all bodies not disposed of within 24 hours after death must be embalmed or refrigerated. If you do not want embalming, we can arrange for refrigeration. You may have the funeral service with an unembalmed body present, but under no circumstances will we allow public viewing of an unembalmed body. The immediate family only (10 people max) will be allowed to view an unembalmed body. All autopsied bodies must have Post-Autopsy care for private family viewing.

22 GENERAL MERCHANDISE AND SERVICES Alternative Containers (minimum fiberboard tray / no interior) $ *This container is included in our Basic (Direct) Cremation service. Urns Clothing $ 95.00/up $ 95.00/up Underclothing Sets (included with purchase of suit or dress) $ Register Book Starting at $ 40.00/up Stationery Set Starting at $ 95.00/up Service Folders / Prayer Cards (100) $ 45.00/up Acknowledgement Cards (50) $ Air Tray $ Combination Shipping Container $ Packaging and Shipping of cremated remains via USPS Registered Mail $ 95.00/up Mailing Death Certificates via USPS Registered Mail $ Express mailing with USPS Plus $ 50.00/up Crucifix $ It is acceptable to purchase multiple crucifixes for several family members Temporary Grave Marker $ Disaster Pouch $ International Documents North, Central and South Americas $ /up Asia, Africa and Europe $ /up There may be additional charges for express mailing, consulate fees, additional mileages to consulate offices, etc. Custom Casket Panel Inserts Veteran Flag Cases $ /up $ /up Scattering of cremated remains (within 25 mile radius of Funeral Home) $100.00

23 CASKET PRICE LIST These prices are effective January 21, 2015 and are subject to change without notice. Standard Metal Selections* S41 Heirloom Pewter 20 gauge steel, ivory crepe interior $ 2, QA2 Ivory Gold 20 gauge steel, ivory crepe interior $ 2, Q01 Sand 20 gauge steel, rosetan crepe interior $ 1, QM2 Aries Copper 20 gauge steel, crepe interior $ 1, QD3 Gemini Copper 20 gauge steel, crepe interior, non-gasketed $ 1, Apollo Flat Black 20 gauge steel, crepe interior, non-gasketed $ Hardwood Selections* 495 Branson Poplar veneer finish, rosetan crepe interior $ 2, BJ Citation Veneer finish, rosetan crepe interior $ 2, Libra Veneer finish, rosetan crepe interior $ 1, Herculite Standard Gray, embossed doeskin cloth, Oval Top $ Cremation Caskets* Ceremonial Oak Rental Veneer finish with insert $ TrayView Fiberboard container $ Alternative Containers* Minimum* Fiberboard tray, no interior, unfinished $ Minimum Oversize Fiberboard tray, no interior, unfinished $ Air Tray Fiberboard tray, Airline Approved shipping container $ Combination Shipping Tray Fiberboard tray, Airline Approved shipping container $ *Minimum: This container is included in our Direct Cremation service. *Standard width caskets may not accommodate the weight of some human remains. Additional charges will apply should an oversized casket be required for the human remains. Disclaimer of Warranties Regarding Caskets: Our funeral home makes no representations or warranties regarding the caskets listed above. The only warranties, expressed or implied, granted in connection with caskets sold are the express written warranties, if any, extended by the manufacturers thereof. Our funeral home hereby expressly disclaims all warranties, expressed or implied, relating to the caskets, including, but not limited to the implied warranties of merchantability and fitness for a particular purpose.

24 OUTER BURIAL CONTAINER PRICE LIST These prices are effective January 21, 2015 and are subject to change without notice. Concrete Burial Vaults (for standard sized caskets) Bronze Triple wall, ABS Fiberlon, Bronze lined interior $ 3, Lydian Triple wall, ABS Fiberlon, Copper lined interior $ 3, Athena Triple wall, ABS Fiberlon, Stainless Steel lined interior $ 2, Patrician ABS Lustra Tech liner $ 1, Tiara Polystyrene liner $ 1, Titan Polystyrene liner $ 1, Graveliners Concrete liner Concrete liner, non-sealing type, standard 30 interior $ In most areas of the country, state or local law does not require that you buy a container to surround the casket in the grave. However, many cemeteries require that you have such a container so that the grave will not sink in. Either a grave liner or a burial vault will satisfy these requirements. Disclaimer of Warranties Regarding Outer Burial Containers: Our funeral home makes no representations or warranties regarding the outer burial containers listed above. The only warranties, expressed or implied, granted in connection with outer burial containers sold are the express written warranties, if any, extended by the manufacturers thereof. Our funeral home expressly disclaims all warranties, expressed or implied, relating to the outer burial containers, including, but not limited to the implied warranties of merchantability and fitness for a particular purpose.

25 AFFILIATED COMPANIES & SERVICES Onion Creek Memorial Park Providing burial and cremation disposition options in a Natural Texas Hill Country setting Chapel Lane Austin, Texas (512) All Faiths of the Pines Funerals & Cremations 110 American Legion Road Smithville, Texas (512) Lic. #3617 Capitol Monument Company Working with people and cemeteries through Care, Service and Quality South Austin 818 FM 1626 Manchaca, Texas (512) Gonzales (Main Office) 5233 North US 183 Gonzales, Texas Toll-free: