General Release NameThis field is for validation purposes and should be left unchanged. 39 Route 435, PO Box 1134, Gouldsboro, PA 18424, Corey Brian Strauch, FD1-855-980-6004www.PennsylvaniaCremationServices.com REQUEST FOR SERVICE RELEASE Your Name*Your Relationship to the Deceased*Full Name of Deceased*hereby release his/her remains to the Pennsylvania Cremation Services, LLC for transportation and *limited preparation for final disposition. *Limited Preparation: is disinfection of the remains, checking the remains for implanted devices(i.e. pacemakers), placing remains in an alternative container, and any other necessary preparations for the cremation process.Time* : Hours Minutes AM PM AM/PM Date* Pennsylvania Cremation Services, LLC Staff*Type your name*Type your name a 2nd time*Type your name again as your digital signature.SignatureYour NameYour NameYour NameYour NameCAPTCHA
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