DIRECT CREMATION SERVICE
Certified Copies of Death Certificate…….With cause of death ($10 ea): Certified Copies of Death Certificate…….Without cause of death ($10 ea):UrnTOTAL DUE (at time of family conference/meeting)
ADDITIONAL SERVICES AND MERCHANDISE
Call for assistance with this (727) 223-5911
ACKNOWLEDGEMENT AND AGREEMENT: I hereby acknowledge that I have the legal right to arrange the final disposition for
the deceased and I authorize this establishment to perform the direct cremation services and other services and merchandise
specified on this statement. By my signature below, I acknowledge that I have received, on this date, the General Price List and
copy of this statement.
TERMS OF PAYMENT: I agree to pay and/or guarantee payment of the charges listed on this statement. In the event of default
of payment, I agree to pay reasonable attorney’s fees and court costs. I agree that the liability is being personally assumed by
me and is in addition to the liability imposed by law upon the estate, and this agreement does not constitute a release of
liability. By my signature below, acknowledgment and agreement of the above are hereby made.
ACCEPTANCE: This establishment agrees to provide all services and merchandise specified on this statement.