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Home
Authority For Release Form
Permission To Cremate Form 1
Death Registration Application Form
Service Areas
Water Cremation
Blog
Gallery: The Gentle Way – Water Cremation
For Pets
Form 1
Queensland Cremations Act 2003 (Section 6(1)) APPLICATION FOR A PERMISSION TO CREMATE
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To:
Coroner
Independent 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.)
please the nominated
I,
*
(print name in full)
whose address for service to be included on the Permission to Cremate is:
Address Line 1
Address Line 2
City
State / Province / Region
Phone
apply for a permission to cremate the human remains of:
*
First
Last
Name of deceased person:
*
First
Last
Usual or last known address of deceased person (if known):
Address Line 1
Address Line 2
City
State / Province / Region
Date of death of deceased person (if known):
place of death of deceased person (if known):
Age of deceased person: (if known):
Date of birth of deceased person (if known):
1. (Complete either A or B - use B only if an agent) A.(Tick one box only)
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 person’s executor or administrator)
another adult person who is making the application because:
If another adult person, please print name here
B. I am an agent of a person referred to in A namely:
(print particular person referred to in A, eg, spouse/sister who is at least 18 years)
2. (Tick one box only)
The deceased person left/did not leave (delete whichever does not apply) signed instructions that his/her (delete whichever does not apply) human remains be cremated.
I do not know whether the deceased person left instructions that his/her (delete whichever does not apply) human remains be cremated.
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).
3. (Tick one box 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 person’s spouse, adult child, parent or personal representative (delete whichever does not apply) 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).
4. (Tick one box only)
The deceased person’s human remains contain a cremation risk (please specify, eg, cardiac pacemaker):
The deceased person’s human remains do not contain a cremation risk.
I do not know whether the deceased person’s human remains 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).
5. (Complete only where the application is to an independent doctor. Tick one box only.) The following documents accompany this application to an independent doctor:
copy of cause of death certificate issued for the deceased person; and a cremation risk certificate for the deceased person (Note: a cremation risk certificate is not necessary if the cause of death certificate is not a Queensland cause of death certificate and a cremation risk certificate has not been issued for the deceased person – section 6(4) and (5) of the Cremations Act 2003.)
a certificate that authorises the release of the body given by a coroner, or person holding a position equivalent to a coroner, at the place where the death happened.
Third Choice
Name, address and telephone number of person nominated to be sent the permission to cremate (Section 6(9) of the Cremations Act 2003). (Complete only if this person is different from the applicant.):
*
First
Last
Address
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Phone
Signature
Clear Signature
Date
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). Form 1 ver. 1 – 31/10/03
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