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Funeral Pre-arrangement Form
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3B Blivest Street,
Oxley, Queensland 4075
(07) 3273 1399
contact@mhfunerals.com.au
Packages
Pre Planning
First Steps
P: (07) 3273 1399
About
Helpful Articles
Forms
Funeral Pre Planning Form
Contact
A
pplication For Permission To Cremate
To
Coroner
Independant Doctor
(The application has to be to a coroner if an autopsy was or is being conducted under the Coroners Act 1958 or the Coroners Act 2003. Otherwise the application is to be made to an independent doctor – section 5 of the Cremations Act 2003.)
I,
(print name in full)
whose address for service to be included on the Permission to Cremate is*:
(print address for service in full)
Telephone No*
apply for a permission to cremate the human remains of:
Name of deceased person*
Sex
Male
Female
Usual or last known address of deceased person
(if known)
Date of birth of deceased person
(if known)
Date of death of deceased person
Age of deceased person*
(if known)
Place of death of deceased person
I am a
Spouse
Child who is at least 18 years
Parent
Brother who is at least 18 years
Sister who is at least 18 years
Appropriate person according to the tradition or custom of the community to which the deceased person belonged (only applies if the deceased was an Aboriginal or Torres Strait Islander)
Personal representative (under section 36 of the Acts Interpretation Act 1954 a personal representative is the deceased persons executor or administrator)
Another adult person who is making the application
An agent of a person for one of the above options
Did the deceased person leave signed instructions that their human remains be cremated?
Yes
No
I do not know
Note: If the deceased person left signed written instructions that his/her human remains be cremated then: • if the personal representative is arranging the disposal of the human remains he/she must ensure an application for a permission to cremate is made (section 7(2) of the Cremations Act 2003); and • there is no obligation to have regard to any objections to the cremation (section 8(1) of the Cremations Act 2003).
Select one option only
To the best of my knowledge I am not aware that any of the following people have any objection to the cremation of the human remains of the deceased person: spouse, adult child, parent or personal representative
The deceased persons spouse, adult child, parent or personal representative has objected to the cremation of the human remains of the deceased person
Note: The Permission to Cremate cannot be issued if there is an objection from one of the persons referred to (section 8(2) of the Cremations Act 2003) unless the deceased person left signed written instructions that his/ her human remains be cremated (section 8(1) of the Cremations Act 2003)
Select one option
The deceased persons human remains contain a cremation risk
The deceased persons human remains do not contain a cremation risk
Note: Human remains pose a cremation risk if the remains contain something that, if cremated, might expose someone to the risk of death, injury or illness (for example, a cardiac pacemaker or radioactive implant: section 6(7) of the Cremations Act 2003).
Name*
Address*
Telephone number
Signature of person making the application*
[signature* signature-664 color:#000000 backcolor:#d3d3d3 width:500 height:100 class:form-control]
Date of application
Note:
1. The address for service is the address which will be used by the crematorium to give notice if it decides to bury any unclaimed ashes after one year: section 11 of the Cremations Act 2003.
2. The application can be sent to the coroner or independent doctor by fax or other electronic means: section 6(3) of the Cremations Act 2003.
3. The permission to cremate can be sent to the applicant, or person nominated by the applicant, by fax or other electronic means: section 6(9) of the Cremations Act 2003.
4. Section 16 of the Cremations Act 2003 makes it an offence to give false or misleading information in a material particular to a coroner or independent doctor. The maximum penalty that can be imposed is 80 penalty units ($6000).