General Release

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39 Route 435, PO Box 1134, Gouldsboro, PA 18424, Corey Brian Strauch, FD
1-855-980-6004
www.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*

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Date*
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Pennsylvania Cremation Services, LLC Staff*
Type your name*
Type your name a 2nd time*
Type your name again as your digital signature.
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