Biographical Information

Biographical Information Form

This form should be used for pre-planning and at-need arrangements. This will allow us to properly file the death certificate, obtain necessary permits, etc.

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Legal Name
Enter the name of the person for whom the arrangements are being made.
Prefix First Middle Last Suffix
Gender
Select the gender of the person for whom the arrangements are being made.
SSN
Social Security Number of the person for whom the arrangements are being made. Leave this field blank to receive a phone call instead.
Date of Birth
Enter the date of birth of the person for whom the arrangements are being made.

MM
DD
YYYY
Date of Death
Enter the date of death of the person for whom the arrangements are being made.

MM
DD
YYYY
Place of Death
Enter the City/Township/Borough in which the deceased passed away.

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Residence Address
Enter the mailing address of the person for whom the arrangements are being made.

Street Address City State ZIP Code
Birthplace
Enter the place of birth of the person for whom the arrangements are being made. If unknown, leave this field blank.
Veteran Status
Was the person for whom the arrangements are being made a member of the Armed Forces of the United States discharged under conditions other than dishonorable?
- Yes
- No
Form DD-214 or Equivalent (Honorable Discharge)
If available, you can upload discharge documents here. Veterans are eligible for military funeral honors, disposition at a National Cemetery, free copies of death certificates, and more.
Drop files here or

Accepted file types: jpg, gif, png, pdf.

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Father's Name
Enter the name of the father of the person for whom the arrangements are being made.
First Middle Last Suffix
Mother's Maiden Name
Enter the full maiden name of the mother of the person for whom the arrangements are being made.
First Middle Maiden Last
Marital Status
Select the marital status of the person for whom the arrangements are being made.
Surviving Spouse's Name
Enter the full name prior to marriage of the surviving spouse of the person for whom the arrangements are being made.
First Middle Last (prior to marriage) Suffix

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Race
Enter the race of the person for whom the arrangements are being made.
Occupation & Business/Industry
Enter the usual occupation and type of business/industry of the person for whom the arrangements are being made. If unknown, leave this field blank. Do not use "Retired."
Education
Enter the highest level of education received by the person for whom the arrangements are being made. If unknown, leave this field blank.

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Informant's Name
In most cases, this will be your name. This will be listed as the next of kin of the person for whom the arrangements are being made.
First Middle Last Suffix
Relationship to Deceased
Enter your relationship to the person for whom the arrangements are being made.
Address
Enter your mailing address.

Street Address City State ZIP Code
Phone Number
Enter your phone number.
Email Address
Enter your email address. If you do not have one, leave this field blank.
1. DECEASED INFORMATION
A. IDENTIFICATION ____________________ The Authorizing Agent has viewed the remains and positively identified them as that of the Decedent; OR ____________________ The personal representative of the Authorizing Agent has viewed the remains and positively identified them as that of the Decedent; OR ____________________ The Authorizing Agent has authorized the Funeral Home to photograph the remains and the Authorizing Agent has positively identified and signed the photograph as that of the Decedent.

B. ARTIFICIAL DEVICES Mechanical devices, artificial implants, pacemakers, and certain nuclear medicine residues may create a hazardous condition when placed in a cremation chamber and subjected to high heat. Please list any Artificial Devices implanted in or attached to Deceased or identify if the Deceased was treated with any Radioactive Materials. Description of Devices: ____________________________________________________________ ____________________ The remains of the Decedent do not contain any of the Devices described in Section 1.B. on the reverse side; OR ____________________ As Authorizing Agent, I/we instruct the Funeral Home to remove each Device listed above and to charge for its services in making or arranging for such removal. Unless indicated directly below, the Funeral Home is to dispose of all such Devices. In any manner it sees fit and at any time. Manner of disposal of devices: _____________________________________________________________________ C. PERSONAL PROPERTY All personal property and effects delivered with the remains of the Decedent to the Crematory, including jewelry, clothes, hair pieces, dental bridgework, eyeglasses, and shoes, will be destroyed in the cremation process or otherwise discarded by the Crematory, in its sole discretion, unless specific instructions for delivery are given below. If no specific instructions are given, I/we release the Funeral Home and Crematory from liability for these items. Items to be delivered to Authorizing Agent or Designee: ____________________________________________________________
2. FUNERAL HOME AND CREMATORY
The Authorizing Agent authorizes the Funeral Home and Crematory set forth below to carry out the directions and instructions of the Authorizing Agent contained in this Authorization. Name of Funeral Home: Griffith Funeral Home, Inc. Address: 5636 Brownsville Road, Pittsburgh, PA 15236 Name of Crematory: Pittsburgh Cremation Service Address: 145 Cemetery Lane, Pittsburgh, PA 15237
3. CREMATION CONTAINER AND URN
A. CREMATION CONTAINER The Crematory requires the remains of Deceased be in a suitable container for cremation. The Crematory may require a combustible cremation container. If the Crematory accepts a non-combustible container, the Crematory is authorized to dispose of the container in any way it sees fit. Type of Container Selected: ______________________________________________________ B. URN An urn to hold the cremated remains may be purchased or provided by the Authorizing Agent but an urn is not required. If an urn is not purchased or provided, the cremated remains will be delivered in a rigid temporary container. _____ Urn purchased by Authorizing Agent. Description of urn: _____________________________________ _____ Urn provided by Authorizing Agent. Description of urn: _____________________________________ _____ Standard temporary container.

1. B. PACEMAKERS, IMPLANTS, AND PROSTHESES
Pacemakers, radioactive, silicon or other implants, mechanical devices or prostheses may create a hazardous condition when placed in the cremation chamber and subjected to heat. As Authorizing Agent, I have listed in Section 1.B. on the reverse side all devices (including mechanical, prosthetic, implants, or materials), which may have been implanted in or attached to the Decedent.
3. A. CASKET OR ALTERNATIVE CONTAINER
The remains are to be cremated in a combustible casket or alternative container that is capable of being completely closed, is resistant to leakage or spillage, is sufficiently rigid to be handled easily, and provides protection for the health and safety of Crematory and Funeral Home personnel. The Crematory is authorized to inspect the casket or alternative container, including opening it if necessary. In the event that the casket or container does not meet the above requirements, the Crematory will notify the Authorizing Agent. Many caskets that are comprised primarily of combustible material also contain some exterior parts (decorative handles or rails) that are not combustible and that may cause damage to the cremation equipment. As Authorizing Agent, I authorize the Crematory, in its discretion, to remove and discard the non-combustible materials. I understand that some crematories will not accept metal or fiberglass caskets. I further understand that the casket or alternative container will be consumed as part of the cremation process.
3. B. URN OR TEMPORARY CONTAINER
After the cremated remains have been processed, they will be placed in the urn listed on reverse side or, if an urn is not provided to the Crematory, in a temporary container provided by the Crematory. The Authorizing Agent acknowledges that it is impossible to recover all of the dust and residue from the cremation and processing. However, 100% of the cremated remains recovered from the cremation chamber and processing equipment shall be prepared for disposition in the manner directed per the written instructions of the Authorizing Agent. In the case of an adult, it is recommended that the urn or temporary container be a minimum size of 200 cubic inches. In the event the urn or temporary container is insufficient to accommodate all of the cremated remains, the excess will be placed by the Crematory in a secondary container. This secondary container will be kept with the urn or the temporary container and handled according to the final disposition instruction set forth in Section 6; provided, however, that the secondary container may not be designed for shipping. All urns or containers provided to the Funeral Home or Crematory must be appropriate for shipping. The Authorizing Agent directs the Crematory to use the specified urn or container listed in Section 3.B. on the reverse side.

4. MULTIPLE CREMATIONS, WITNESS, SERVICE, AND TIME
A. MULTIPLE CREMATIONS ____________________ As Authorizing Agent, I authorize the simultaneous cremation of the remains of the Decedent with the decedent named below. I certify that this multiple cremation meets the legal requirements set forth on the reverse side. Name of Other Decedent: ____________________________________________________ B. WITNESSING Some crematories may allow witnessing of the initial cremation process. As authorizing agent I allow: ____________________ No witnesses; OR ____________________ (List of Witnesses): _____________________________________________________________________ (Witnesses must sign individual Cremation Witness Acknowledgement) C. SERVICES Prior to the cremation of the Decedent's remains, a visitation and/or funeral ceremony was arranged as set forth below: Date(s): _____________________ Time(s): _____________________ Location: _______________________________ D. TIME The cremation of the Decedent's remains cannot take place until all legal requirements including a waiting period have been fulfilled. If the remains are not embalmed and if the cremation is not to occur immediately upon delivery of the remains to the Crematory, the Crematory will place the remains in a refrigerated facility for which there may be a daily charge as stated in the General Price List. Decedent's remains: ___ are to be embalmed. ___ are not to be embalmed. Please initial one of the following: ____________________ The Crematory may perform the cremation of the Decedent's remains at a time and date as its work schedule permits and without any further notification to the Authorizing Agent. OR ____________________ The Crematory is to use its best efforts to schedule the cremation in accordance with the schedule set forth below: Date: _______________________Time: _______________________
5. AUTHORIZATION
A. AGENT As Authorizing Agent, I/We represent that I/We have the right to authorize the cremation of the Decedent's remains and warrant: ____________________ As Authorizing Agent, I/we have filled in Section 5.A. I/We understand that any living person who meets the qualifications of any level above or equal to the one I/we filled in would have a superior or equal right to act as the Authorizing Agent. I/We do not have actual knowledge of the existence of any living person who has a superior or equal right to act as the Authorizing Agent. *See notes to 5. A. on reverse side.

Name of Authorizing Agent Address Telephone Relationship

B. CREMATION PROCESS ____________________ As Authorizing Agent, I/we have read and understand the description of the cremation process contained in Section 5.B. on the reverse side and authorize the cremation, processing and pulverization of the remains of the Decedent. I/we further authorize the Funeral Home to deliver the Decedent's remains to the Crematory for the purpose of the cremation.

4. A. MULTIPLE CREMATION
Under STATE law, the remains of more than one decedent may not be simultaneously cremated in the same cremation chamber unless there is a specific request by the Authorizing Agent instructing to the contrary for extenuating circumstances such as but not limited to: the simultaneous death of a parent and child, the decedents to be cremated were related, living in a common law marital relationship or cohabitating. Unless authorized on the reverse side, the Decedent’s remains shall be individually cremated. The crematory shall reserve the right to agree or decline a special request by an Authorizing Agent. If you desire a multiple cremation, initial Section 4.A. on the reverse side.
4. B. WITNESSING
The Authorizing Agent, being advised of their right to witness the placement of the deceased into the cremation chamber, shall accept or decline this offer in writing. Witnessing a cremation can be an emotional experience. Witnesses are assuming the risks involved and fully release the Funeral Home and Crematory from any liability. To the extent permitted by the Crematory, the persons listed on the reverse side are authorized to be present prior to and during the cremation of the Decedent's remains and during the removal of the cremated remains from the cremation chamber. Witnessing of any aspect of the cremation and processing procedure shall be in compliance with all applicable law and any safety regulations. If you desire witnesses, you must initial Section 4.B. on the reverse side, list the witness names, and all witnesses must sign an additional Cremation Witness Acknowledgment.
5. A. IDENTIFICATION OF AUTHORIZING AGENT
Authorization signature(s) of legal immediate surviving representative(s) are required in the following order: 1. Spouse 2. All Children 3. All Surviving Parents 4. All Brother(s)/Sister(s) 5. All Grandchildren 6. All Grandparents
5. B. THE CREMATION PROCESS
The cremation of the Decedent's remains may take place before or after ceremonies to memorialize the Decedent. Cremation is performed to prepare the remains of the Decedent for final disposition. It is carried out by placing the Decedent's remains in the casket or alternative container, which is then placed into a cremation chamber or retort where they are subjected to intense heat and flame. All cremations are performed individually unless noted otherwise in Section 4.A. During the cremation process, it may be necessary to open the cremation chamber and reposition the remains of the Decedent in order to facilitate a complete and thorough cremation. Through the use of suitable fuel, the incineration of the container and its contents is accomplished and all substances are consumed or driven off, except bone fragments (calcium compounds) and metal (including dental gold and silver and other non-human materials) as the temperature is not sufficient to consume them. Due to the nature of the cremation process, any personal possessions or valuable materials, such as dental gold or jewelry (as well as any body prostheses or dental bridgework) that are left with the remains and not removed from the casket or container prior to cremation may be destroyed or if not destroyed, will be disposed of by the Crematory. The Authorizing Agent understands that arrangements must be made with the Funeral Home to remove any such possessions or valuables prior to the time that the remains of the Decedent are transported to the Crematory. Following a cooling period, the cremated remains, which will normally weigh several pounds in the case of an average-size adult, shall be recovered by manual means, such as brushing, and industry-specific mechanical means, such as vacuuming, in order to retrieve the cremated remains from the cremation chamber. Although the Crematory will take reasonable efforts to remove all of the cremated remains from the cremation chamber, some dust and other residue from the process will be left behind. In addition, while every effort will be made to avoid commingling, inadvertent and incidental commingling of minute particles of cremated remains from the residues of previous cremations is possible. The Authorizing Agent understands and accepts this fact. After the cremated remains are removed from the cremation chamber, all non-combustible material (insofar as possible) such as hinges, latches, and nails from the container will be separated and removed from the human bone fragments by visible or magnetic selection. Other non-bone fragment foreign material that was part of the deceased prior to cremation and recovered with the cremated remains, such as an internal prosthesis, shall be removed prior to processing so that only human bone fragments will remain. Non-bone fragment foreign material may be commingled with other like material and shall be disposed of in a dignified manner, such as burial in a cemetery, in accordance with all applicable laws. The Crematory is authorized to dispose of these materials with similar materials from other cremations in a non-recoverable manner. When the cremated remains are removed from the cremation chamber, the skeletal remains often will contain recognizable bone fragments. Unless otherwise specified, after the bone fragments have been separated from the other material, they will be mechanically processed, pulverized. The process of crushing or grinding may cause incidental commingling of the remains with the residue from the processing of previously cremated remains. These granulated particles of unidentifiable dimensions, which are virtually unrecognizable as human remains, will then be placed into a designated container.

6. FINAL DISPOSITION
Cremated remains shall only be released, delivered, mailed or disposed of by the Cemetery or Funeral Home in a dignified manner, in accordance with the law, and with the express written consent of the Authorizing Agent. ______________ Location will deliver or mail (register-return receipt) the cremated remains to the name and address listed below for: ___ personal disposition ___ inurnment ___ interment ___ scattering. ______________ The cremated remains will be held by Location for pick-up, and Location is authorized to release the cremated remains to name and address listed below: Name (Designee): Griffith Funeral Home, Inc. Relationship: Funeral Home Address: 5636 Brownsville Road, Pittsburgh, PA 15236 ______________ Other Method Disposition (Describe): ___________________
7. CERTIFICATION AND INDEMNIFICATION
I/We have the right and hereby authorize the cremation of the Deceased and the disposition of the cremated remains pursuant to the regulations of the Crematory and the instructions on this form. I/We agree to release and indemnify the Funeral Home and the Crematory, their officers, directors, agents and employees, from any claim, liability, cost or expense resulting from the Funeral Home’s and the Crematory’s reliance on or performance consistent with the directions, declarations, representations, authorizations and agreements herein. I/We release the Funeral Home and Crematory from liability for the cremated remains upon delivery to a reputable common carrier. I/We agree that the Funeral Home’s and Crematory’s liability for future negligent acts (of itself or its agents or employees) is limited to a refund of the cremation fees paid to the Funeral Home and/or Crematory by me/us. I/We warrant that all representations and statements contained in this form are true and correct. These statements are being relied upon by the Funeral Home and Crematory. I/We have read and understood all pages of this document. This authorization for cremation and disposition was executed at ___________________________________, this _______________ day of ____________________, 2018. Signature of Authorizing Agent:_____________________________ Signature of Authorizing Agent:_____________________________ Signature of Authorizing Agent:_____________________________ Signature of Authorizing Agent:_____________________________ Signature of Authorizing Agent:_____________________________ Signature of Authorizing Agent:_____________________________ Witness*:_____________________________________________________ *If a Funeral Director witnesses the execution of this Authorization by the Authorizing Agent, the Funeral Director verifies the accuracy of the identity of the Decedent and the representation that a Burial Permit or Burial Transit Permit authorizing the cremation of the Decedent's remains has been obtained.
8. CERTIFICATE BY FUNERAL HOME UPON TRANSFER OF DECEDENT'S REMAINS TO CREMATORY
The Funeral Home certifies that the remains being transferred to the custody of the Crematory are those of the Decedent identified in Section 1 hereof and that the Funeral Home, based upon the representations of the Authorizing Agent in Section 5 hereof, has taken reasonable precautions to ensure the removal of any Device listed in Section 1.B. from the Decedent's remains or to render such Device non-hazardous. The Funeral Home also certifies that any items listed in Section 1.C. hereof have been removed from the remains of the Decedent for the purpose of delivery to the Authorizing Agent. Date: __________________ By: _______________________

6. FINAL DISPOSITION
Following the cremation, the Authorizing Agent directs the Crematory and/or Funeral Home to undertake the actions set forth on the reverse side to arrange the final disposition of the cremated remains of the Decedent. Cremated remains shall only be released, delivered, mailed or disposed of by the Cemetery or Funeral Home in a dignified manner, in accordance with the law, and with expressed written consent of the Authorizing Agent. If the cremated remains are shipped at any time, the Authorizing Agent directs that the Crematory or Funeral Home utilize registered U.S. mail with a return receipt or a shipping service that uses an internal system for tracing the location of the cremated remains during shipment and requires a signed receipt of the person taking delivery of the cremated remains. The Authorizing Agent understands that if no arrangements for the final disposition, release or shipment of the cremated remains are made in this Authorization, the Crematory shall hold the cremated remains for thirty (30) days after cremation. If during that thirty (30) day period the cremated remains are not retrieved by the person designated above to receive them or by the Authorizing Agent, or if arrangements for their final disposition are not made, then the Crematory will return the cremated remains to the Funeral Home or the Authorizing Agent at the address listed in Section 6. In the alternative, if no arrangements for the final disposition of the cremated remains have been made within sixty (60) days after the cremation and if the Authorizing Agent has not taken delivery of or caused the delivery of the cremated remains, or in the event the arrangements of the final disposition have not been carried out within the sixty (60) day period because of the inaction of a party other than the Crematory or Funeral Home, then the Funeral Home may dispose of the cremated remains in a grave, crypt or niche. The Authorizing Agent shall be liable for the cost of such final disposition in a grave, crypt or niche and shall reimburse the Funeral Home immediately upon receipt of an invoice.
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Name of Authorizing Agent	Address	Telephone	Relationship