FORM MAY BE REPRODUCED FOR PERSONAL USE ONLY - NO COMMERCIAL USE APPROVED
Form provided by Barton Family Funeral Service LLC serving northwest Washington State - www bartonfuneral.com
For Individual Use under Provisions of the Revised Code of Washington 68.50.160
Release my cremated remains to the following person. If that person is unable to accept receipt of my
remains, I direct that they be released to the second named person.
I direct that the funeral service or crematory release my cremated remains to the following person(s):
I, __________________________________________________declare that it is my wish and I hereby authorize and
direct that upon my death, my remains be Cremated. I understand that "Cremation" as defined by the Washington
Administrative Code (WAC 98-80-010) means the reduction of human remains to bone fragments in a crematory by
means of incineration.
Special Instructions to my survivors regarding disposition of my remains:____________________________________
( Under Washington Law, this form must be signed in the presence of a witness)
I direct that all of my relatives, surviving at my death, honor this authorization, and that no funeral home, funeral
service, cemetery and/or crematory shall be liable for arranging for or undertaking disposition of my remains if done in
reliance on this authorization. Further, I direct that my estate, heirs, legal and personal representatives, at their sole
expense, shall defend,