HUCKLEBERRY CREEK Selections Form

FAMILY CONTACT INFO

Name of Decedent*:

Name of Person Making Arrangements*:

Phone Number*:

Email*:

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:

• Removal & Transport of decedent less than 300lbs from a Hospital morgue or Coroner/ME in our 9 County Service Area. Includes King, Kitsap, Lewis, Mason, Pierce, Thurston, Grays Harbor, Jefferson, and Pacific Counties.
• NO Hidden Fees or Extra Mileage Charges.
• Refrigeration and Sheltering
• Filing the death certificate, notifying SSA
• Cremation
• Black plastic urn
• Complimentary Mailing of the Urn in WA, USPS Priority Express
• Or Pickup at our Office in Tumwater, WA

CREMATION PACKAGE

Select Cremation Type*:

Standard Cremation ($695.00)

 

Before we can complete a cremation we are required to obtain a permit from the WA Health Dept. This means that the family of the deceased must complete the  Death Certificate Worksheet so we can submit the provided information to get the permit. Also, we can not begin a cremation until all the required  Cremation Authorizations are completed. Please let us know the time frame you will be able to complete these required forms. Simply right click on the links to open them in a new tab or window. They can also be found on our resources page. Please note that if you go beyond the selected time frame then additional charges will incur.

Required Family Paperwork To Complete*:

I will complete Death Cert. Worksheet and Cremation Authorizations in <5 Calendar Days ($0.00) I will complete Death Cert. Worksheet and Cremation Authorizations in <10 Calendar Days ($150.00) I will complete Death Cert. Worksheet and Cremation Authorizations in <15 Calendar Days ($300.00)

Select Decedent Weight*:

Less than 300lbs ($0.00) 300-349lbs ($995.00) 350-399lbs ($1,295.00) 400-499lbs ($1,595.00) 500-599 ($1,895.00)

REMOVAL & TRANSPORT

What county are we picking up the decedent?*:

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

Location where we'll be picking up the decedent?*:

Coroner or Medical Examiner Facility ($0.00) Hospital Morgue ($0.00) Other Funeral Home ($0.00) Nursing Facility or Hospital Bedroom (1 Staff - Immediate Response) ($300.00) Residence House or Apartment (2 Staff - Immediate Response) ($500.00)

Name & Address of Location (If Known):

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)

Huckleberry Creek Cremation does not offer identification or formal viewings, nor does it offer any type of witness cremation.

VIEWING & WITNESS ACKNOWLEDGEMENT

Viewing Acknowledgement*:

I acknowledge that HCC does not offer identification or formal viewings, nor does it offer any type of witness cremation. ($0.00)

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)

Direct cremation normally takes 1-2 weeks. Would you like to "cut-in-line" and expedite the process? RUSH Cremation takes place 2-3 business days after the permit is obtained. PRIORITY RUSH takes place the next business day after a the permit is obtained.

EXPEDITE "RUSH" CREMATION

Select Rush Cremation*:

No RUSH needed ($0.00) Add RUSH Cremation ($195.00) Add PRIORITY RUSH ($295.00)

ADDITIONAL SELECTIONS

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)

Witness Laying in Chamber*:

No Witness Cremation ($0.00) Witness Laying in Chamber ($900.00)

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:

. 

URNS, JEWELRY & KEEPSAKES (Optional)

________

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) Add Simple Engraving ($198.00) Add Premium Engraving ($330.00)

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.

RETURN THE CREMATED REMAINS

Instructions for returning the cremated remains*:

Hold for Pick-up in Tumwater ($0.00) Mail Plastic Urn (in WA) ($0.00) Unattended Water Scattering Unspecified ($0.00) Mail Plastic Urn in US ($195.00) Mail Non-Plastic/Other Urn in US ($275.00) Hand-Delivery to your Home or Office (Lewis, Grays Harbor, Pierce, Thurston, Mason) ($100.00) Hand-Delivery to your Home or Office (King, Jefferson, Pacific, Kitsap) ($200.00)

Name & Address for Shipping Ashes:

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.

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*:

No DCs Ordered ($0.00) Hold DCs for Pick-Up ($0.00) Hand Deliver DCs with Urn ($0.00) Mail DCs No Tracking ($0.00) Mail DCs with Tracking ($18.00)

Name & Address for Mailing DCs:

OTHER GOVERNMENT ITEMS

Required WA State Fee*:

 WA State Cremation Fee ($10.80)

What County Did the Death Occur (County Permit Fee)?*:

Thurston County Permit Fee ($0.00) Mason County Permit Fee ($0.00) Lewis County Permit Fee ($0.00) Grays Harbor Permit Fee ($0.00) Kitsap Permit Fee ($0.00) Pacific County Permit Fee ($0.00) Jefferson County Permit Fee ($0.00) Pierce County Permit Fee ($15.00) King County Permit Fee ($100.00) Clark County Permit Fee ($100.00) Snohomish County Permit Fee ($15.00)

VETERAN OPTIONS

Complete Flag App & Retrieve US Flag*:

Not a Veteran Do not want a Flag Retrieve Flag at Post Office

Select Flag Case:

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

Schedule National Cemetery:

No National Cemetery ($0.00) Add National Cemetery Scheduling ($295.00)

Upload Discharge Paperwork (DD214):

MEMORIAL WEBSITE PHOTO

Please Upload a Photo of Your Loved One:

HOW DID YOU HEAR ABOUT US?

Please select how your heard about our firm*:

Nisqually Valley News ($0.00) ValPak ($0.00) The Chronicle ($0.00) The Olympian ($0.00) The Daily World ($0.00) Referred ($0.00) Direct Mail ($0.00) Internet Search ($0.00) Other ($0.00)