Address: 1289 Forest Avenue, Suite A, Staten Island, NY, 10302, US
Telephone: (718) 887-8168

The following information will be used for completion of all legal documents. Including, but not limited to, certified death certificates, cremation permits, social security notification and veteran claim forms. Required fields are marked with an "*".

Step 1 of 5

Designation of Intentions Form 2 of 5
Required fields are marked with an *
Customer's Designation of Intentions
Place of Cremation
Scheduled Date of Cremation
MM slash DD slash YYYY
Authorizing Party:
- Copy information from Informant
Name
Address
Street Address City State ZIP Code
Telephone
Relationship to Deceased
Direction for Disposition of Cremains:
1. Return to
2. Burial in

Cemetery
3. Placement in Niche at

Cemetery
4. Other
Cremains which shall not have been claimed within 120 days from the date of cremation may be disposed of by this firm, in the following manner of disposition: Scatter at sea.
Dated
MM slash DD slash YYYY
Signature of Authorizing Party*

Application for Cremation Permit Form 3 of 5
To the Office of Vital Records, Department of Health, The City of New York, State of New York
Country of
} SS. (namely or particularly)
being duly sworn deposes and says that
- he
- she
Resides at
Street Address City State ZIP Code
and desires that a permit be issued by the Department of Health of the City of New York for the cremation of the body of
Deceased Name
who died at
on
MM slash DD slash YYYY
Deponent's assumption of authority to act is based upon the following:
Deponent further states that the deceased
- did
- did not
express during life the desire to have
- his
- her
remains cremated and
- his
- her
relationship to deceased is
Deponent assumes all responsibility for the cremation of the remains and authorizes
a licensed funeral director, to make arrangements for said disposal.
Subscribed and sworn to before me this
MM slash DD slash YYYY
Signature of Informant*
Enter Name Again to Confirm*

Confirmation of Identification Without Viewing Form 4 of 5
Part I. To be completed by Funeral Home representative whenever there is no visual identification
Name of Deceased
Reason visual identification not performed
Describe alternative methods used to confirm identification (e.g., photographs, scars, tattoos, etc.)
Name of individual providing information
Part II. To be completed by next of kin or other legally authorized persons making arrangements
I,
Having declined to make identification through actual viewing of the remains of
Hereby agree to indemnify and hold the All Boro Cremation Services, LLC. and its officers, directors, shareholders, affiliates, agents, employees, successors, and assigns harmless from any and all claims, liabilities, damages, losses, suits or causes of action (including attorney's fees and expense of litigation) brought by any person, firm or corporation or the personal representative thereof, relating to or arising out of such failure to identify.
Signature*
Relation to Deceased*
Print Name*
Date
MM slash DD slash YYYY

At-Need Written Statement of Agent Claiming Legal Control of Disposition Form 5 of 5
I,
,hereby represent and asser that I am entitled to control the disposition of the remains of
,who named me as his/her designated agent in a will or written instrument executed pursuant to Section 4201 of the NYS Public Health Law.
Date
MM slash DD slash YYYY
Signature of Agent*
Comments
This field is for validation purposes and should be left unchanged.

Vital Information Form

Step 1 of 5

Vital Information Form 1 of 5

Under 1 Year

Under 1 Day

Place of Death

Designation of Intentions Form 2 of 5

Application for Cremation Permit Form 3 of 5

Confirmation of Identification Without Viewing Form 4 of 5

Part I. To be completed by Funeral Home representative whenever there is no visual identification

Part II. To be completed by next of kin or other legally authorized persons making arrangements

At-Need Written Statement of Agent Claiming Legal Control of Disposition Form 5 of 5

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