HUCKLEBERRY CREEK Arrangement Form

GENERAL PRICE LIST

GENERAL PRICE LIST

Acknowledgment*:

 I have received the Price List

WHEN DO YOU NEED OUR SERVICES?

Select Timing of Need*:

Immediately (My loved one has passed) ($0.00) Soon (My loved one's passing is imminent- 6mo or less) ($0.00)

INCLUDES:

• Services of Funeral Director and Staff
• Removal of Decedent (<300lbs) from a Morgue at a Hospital, Coroner, Medical Examiner, or other Funeral Home
• Refrigeration/Sheltering
• Cremation Process
• Alternative Container
• Memorial Webpage
• Black Plastic Urn with Logo Receiving Bag
• Release of Cremated Remains at our office
• Order and Obtain Death Certificates from Health Department

CREMATION PACKAGE

Select Cremation Type*:

Standard Cremation ($495.00) Aquamation ($1,495.00)

Select Decedent Weight*:

Less than 300lbs ($0.00) 300-349lbs ($495.00) 350-399lbs ($695.00) 400-499lbs ($895.00) 500-599 ($1,095.00)

REMOVAL & TRANSPORT

What county are we picking up the decedent?*:

Thurston County ($0.00) Lewis County ($200.00) Mason County ($200.00) Grays Harbor County ($200.00) King County ($400.00) Jefferson County ($500.00) Kitsap County ($200.00) Pacific County ($300.00) Pierce County ($200.00) None of these

Type of Removal Location?*:

Nursing Facility (1 Staff - Immediate Response) ($200.00) House or Apartment (2 Staff - Immediate Response) ($300.00) Hospital ($0.00) Coroner or Medical Examiner Facility ($0.00) Other Funeral Home ($0.00)

Name & Address of Location (If Know):

Transport (Outside Primary Service Area):

Clallam ($1,000.00) Wahkiakum/Cowlitz ($800.00) Kittitas/Yakima ($1,000.00) Clark/Skamania ($1,000.00) Snohomish ($800.00) Skagit ($1,000.00) Whatcom ($1,200.00) Other WA County ($1,500.00) Portland, OR Metro ($1,000.00)

. 

URNS, JEWELRY & KEEPSAKES (Optional)

________

If you plan to bring in a family provided urn or any urn or jewelry not purchased from our firm, then there is a charge added for our service in transferring and placing Cremated Remains into your provided item or items (per 10 items). This charge also covers requests to split the Cremated Remains into multiple sections or portions in order to be given to multiple people. Please provide any instruction for us here.

URN FILLING/SPLITTING

Select Filling/Splitting*:

No Filling/Splitting ($0.00) Fill Family Provided Urn ($75.00) Split Cremated Remains ($75.00) Fill & Split ($75.00)

Additional Instructions for Filling/Splitting:

Simple Engraving = Full Name and Dates

Premium Engraving = Custom Text, Photo, etc. as available on the item to be personalized

URN ENGRAVING

Add Urn Engraving:

No Engraving ($0.00) Undecided About Engraving ($0.00) Add Simple Engraving ($195.00) Add Premium Engraving ($295.00)

Direct cremation normally takes 1-2 weeks. Would you like to "cut-in-line" and expedite the process? Rush Cremation takes place 1-2 days after the permit is obtained and authorizations are secured.

EXPEDITE "RUSH" CREMATION

Select Rush Cremation*:

No RUSH needed ($0.00) Add RUSH Cremation ($195.00)

ADDITIONAL SELECTIONS

Remove Pacemaker*:

No Pacemaker ($0.00) Unsure if Pacemaker ($0.00) Remove Pacemaker ($0.00)

Take Fingerprint for Jewelry*:

No Fingerprinting ($0.00) Add Fingerprinting ($25.00)

Take Locket of Hair*:

No Locket ($0.00) Add Take Locket of Hair ($25.00)

VETERAN OPTIONS

Complete Flag App & Retrieve US Flag*:

Not a Veteran Do not want a Flag Retrieve Flag at Post Office ($45.00)

Select Flag Case:

No Flag Case ($0.00) Add Flag Case ($150.00)

Minimum Preparation of an unembalmed body is required for any viewing (whether paying your respects for 5 minutes or an hour) in order to ensure a safe, clean, and peaceful experience for all. The Min. Preparation charge includes the minimum preparations and use of facility and staff for a one hour ID viewing at the Shelton facility during the week M-F before 4pm. Overtime is anytime after 5pm or Saturday-Sunday. Some families prefer to upgrade to Embalming preparation for viewing even though it is not required for an ID viewing. If you choose "No Viewing" then you acknowledge that no one will need to view the decedent prior to the cremation. Autopsy Restoration is required for viewing if the decedent has had an autopsy. Dressing is optional and if not selected, then we will use the clothing that was on the decedent when they came into our care or a clean gown as needed.

WILL THERE BE ANY VIEWING?

Select Preparation For Viewing*:

No Viewing ($0.00) Min. Prep. & Facility for 1hr Family Viewing ($700.00) Min. Prep. & Facilty for Family Dressing ($700.00) Embalming & Facility for 1hr Public Viewing ($895.00) Autopsy/Tissue Restoration & Facility for 1 hr Family Viewing ($1,395.00)

Select Dressing*:

No Dressing ($0.00) Add Use of Facility for Dressing by Family ($175.00) Add Dressing by Staff ($195.00)

Select Overtime for Viewing*:

No Overtime for Viewing ($0.00) Overtime for Viewing (M-F after 4pm ($195.00) Overtime for Viewing (Saturday) ($395.00) Overtime for Viewing (Sunday) ($595.00)

What would you like us to do with the Cremated Remains when they are ready to be returned to the family? If Shipping or Delivery, please provide the address.

HOW WOULD YOU LIKE TO RECEIVE THE ASHES AFTER CREMATION?

Instructions for returning the cremated remains*:

Hold for Pick-up at the Tumwater Office ($0.00) Hand-Delivery (Up to 35miles) ($150.00) Package & Ship Plastic Urn in WA ($150.00) Package & Ship Plastic Urn in US ($195.00) Package & Ship Other Urn ($275.00) Unattended Water Scattering Unspecified ($75.00)

Name & Address for Shipping Ashes:

How should we return any personal items that the family wants returned? If Shipping or Delivery, please provide the address.

DOES YOUR LOVED ONE HAVE PERSONAL ITEMS YOU NEED RETURNED?

Instructions for returning any personal items*:

Not Applicable ($0.00) I Don't Know ($0.00) Hold for Pick-up ($0.00) Hand-Delivery (Up to 35miles) ($150.00) Mail Personal Items in WA ($35.00) Mail Personal Items in US ($65.00)

Name & Address for Mailing Personal Items:

PLEASE ADD PHOTO & TEXT FOR MEMORIAL WEBPAGE

Type Text for Online Memorial Page:

Upload Word Doc for Online Memorial:

 

 

Upload Photo:

Many families need one or more official certified copies of the death certificate to take care of certain estate, probate, or other business following a death. Certified Death Certificates are ordered and obtained from the local health department. If you have been informed by the ME or Coroner that the Cause of Death is PENDING- we recommend that you only order ONE death certificate at this time. Once the cause of death has been updated in the system then you can order more at that time. You can have our firm order and obtain official certified copies of the death certificate from the health department for you to pickup at our office or for mailing. You may also order and obtain them directly. IMPORTANT NOTE: Certain information you provide here in this online planner (especially the Vital Information) will be placed on the Death Certificate. We do not contact the family to check and verify if the information you provide is correct. We expect that your input is submitted accurately as you intend it. If changes or corrections are requested after the Death Certificate has printed and the corrections required are due to family error, then an additional administrative fee of $75 will be incurred to reorder and reobtain new corrected Death Certificates. Plus the cost of the corrected Death Certificates.

DEATH CERTIFICATES

How many Death Certificates?*:

No Death Certificates ($0.00) 1 Death Certificate ($25.00) 2 Death Certificates ($50.00) 3 Death Certificates ($75.00) 4 Death Certificates ($100.00) 5 Death Certificates ($125.00) 10 Death Certificates ($250.00)

Instructions for returning Death Certificates*:

Mail Death Certificates ($25.00) No DCs Ordered ($0.00) Hold DCs for Pick-Up ($0.00)

Name & Address for Mailing DCs:

OTHER GOVERNMENT ITEMS

Required WA State Fee*:

 WA State Cremation Fee ($10.80)

Select County of Death Fee*:

Clark County Permit Fee ($70.00) King County Permit Fee ($100.00) Pierce County Permit Fee ($10.00) Snohomish County Permit Fee ($15.00) Other County ($0.00)

Would you like to help a less fortunate family by contributing funds to help cover their funeral or cremation expenses?

PAY-IT-FORWARD

Select Amount*:

No donation $25 donation $50 donation $100 donation $250 donation $500 donation $1000 donation