burial options - pittsburgh, pa john d. o'connor funeral home · 5106 second avenue,...

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Patrick R. Vereb, Sr., Funeral Director & Supervisor ~ David O’Connor, Funeral Director

5106 Second Avenue, Pittsburgh, Pennsylvania 15207-1725

Website: OConnorFuneralHomePittsburgh.com ~ e-mail: [email protected]

Telephone: 412-521-8116 Fax: 412-521-8250

General Price List Effective October 15, 2019

These prices are subject to change without notice. Please check with us for possible changes if your purchase is deferred. The goods and services shown below are those we can provide to our clients. You may choose only the items you desire. However, any arrangements you select will include a charge for our basic services and overhead. If legal or other requirements mean you must buy an item you specifically did not ask for, we will explain the reason in writing on the statement we provide describing the funeral goods and services you selected. Nothing the funeral director or anyone else may say should be taken as modifying or differing from the goods and services you selected and agreed to as shown on the STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED.

Burial Options

If you’ve chosen to have your loved one buried, you may want the casket present at the

service. Many people choose to hold a viewing prior to the service. Whichever option you

choose, we will work with you to ensure that you have every opportunity to bring family

and friends together to say a final goodbye before the burial.

The fees include professional services. The transfer of the deceased from the place of death

into our care within a 25 mile radius and to the place of rest or crematory. Filing the death

certificate and notifying Social Security. Preparation of newspaper notices if desired and

handling of floral tributes if any.

Some packages may include merchandise such as a casket or urn, and cash advances, such

as the Medical Examiner and cremation fees. Any cash advances not listed would be an

additional fee; such as a cemetery outer burial container, clergy costs, obituaries, flowers,

and death certificates. You may also consider memorial items such as personalized

prayer cards or folders, a visitor’s register book, a Video Memorial Tribute,

personalized bookmarks, candles, or jewelry if they are not included in the package

selected.

mailto:[email protected]

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Telephone: 412-521-8116 Fax: 412-521-8250

TRADITIONAL FUNERAL SERVICE

VISITATION, FUNERAL SERVICE, INTERMENT $3,995.00

This package includes the basic service of the

funeral director and staff, transfer of the

deceased to the funeral home within a 20 mile

radius, embalming, dressing and casketing, use

of facilities and staff for one or two days of

visitation, funeral ceremony or services in our

funeral home or another facility, and interment, hearse for

service, lead vehicle if necessary, a committal service, a visitor’s

register book, prayer cards, thank you cards, a Memorial Tribute

DVD, a memorial candle or a crucifix for inside the casket,

attention to all details including filing of forms with government

offices, preparation of obituaries and handling of floral tributes.

Other items to be considered (Not included in our fee) would be a

casket, outer burial container and any/or all cash advances such

as cemetery fees, newspaper fees, clergy costs, flowers, certified

copies of the death certificates ($20.00 each).


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Telephone: 412-521-8116 Fax: 412-521-8250

PRIVATE VIEWING FOR FAMILY

DIRECT BURIAL, OR A GRAVESIDE SERVICE IF REQUESTED $1,995.00

This package includes the basic services of the funeral director and staff with minimum preparation of the deceased. The use of facilities for 30 minutes of visitation with an open casket before the Funeral Service or direct burial.

A visitor’s register book, personalized prayer cards, thank you cards, a cross or crucifix for inside the casket or a Memorial candle, if desired, a Memorial Tribute DVD if desired.

A funeral ceremony or services in our funeral home or another facility, a hearse if necessary within a 25 mile radius, a lead vehicle if necessary and a committal service.

Other items to be considered (Not included in our fee) would be the cemetery fees: a cemetery space, an outer burial container, the grave opening and closing fees, and any/or all cash advances such as newspaper fees, clergy costs, flowers, certified copies of the death certificates, ($20.00 each).


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Telephone: 412-521-8116 Fax: 412-521-8250

NO VIEWING. A FUNERAL SERVICE OR A DIRECT BURIAL ONLY $995. 00

This package includes the basic service of the

funeral director and staff, transfer of the

deceased to the funeral home within a 20 mile

radius, dressing and casketing, hearse for

service, Either a Funeral Ceremony in our funeral

home or elsewhere with a Direct Burial or a

Graveside Service with no Funeral Ceremony. If desired, a

visitor’s register book, prayer cards, thank you cards, attention to

all details including filing of forms with government offices,

preparation of obituaries and handling of floral tributes. Other

items to be considered (Not included in our fee) would be a

casket, outer burial container and any/or all cash advances such

as cemetery fees, newspaper fees, clergy costs, flowers, certified

copies of the death certificates ($20 each), personalized memorial

items such as a Memorial Tribute DVD, and a Memorial Candle.


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Telephone: 412-521-8116 Fax: 412-521-8250

THE GREEN BURIAL PLAN $1,495.00

According to the National Funeral Directors Association (NFDA), a not-for-

profit trade group representing funeral service professionals, a green burial

occurs when "the body is buried, without embalming, in a natural setting; any

shroud or casket that is used must be biodegradable, nontoxic, and of

sustainable material; traditional standing headstones are not permitted. Instead,

flat rocks, plants or trees may serve as grave markers."

NFDA adds that green burial "may also simply mean burial without embalming, in a

biodegradable casket without a vault, when permitted by a cemetery."

This package includes the basic service of the funeral director and staff, transfer of the

deceased to the funeral home within a 20 mile radius, a biodegradable sheet or shroud, a

hearse for service if desired, , a committal service if desired,

Other items to be considered may include any/or all cash advances such as cemetery fees,

newspaper fees, clergy costs, flowers, certified copies of the death certificates, personalized

memorial items such as a DVD Memorial Tribute.

In this case it is a stand-alone event. This charge of $1,495.00 does not include: embalming,

a casket, use of facilities or staff for any visitation or ceremony, public or private, prior to

interment. If embalming using fluids consistent with green burial standards the fee would

be added to the $1,995.00. If the cemetery requires a bio-degradable casket, the fee will be

added to the $1,995.00.

Green Cemeteries to consider are:

1. Penn Forest Cemetery in Verona,

2. St. Francis of Assisi green burial section, in a quiet meadow behind Holy Savior Catholic

Cemetery off Bakerstown Road in Pine and Richland Townships

3. Or any other cemetery offering Green Burial


http://www.nfda.org/

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Telephone: 412-521-8116 Fax: 412-521-8250

Traditional Funeral Service with Cremation

The term “Traditional Funeral Service”, when referring to a cremation, mean those

services in which the casket or urn will be present, just as though there was to be a casket

burial. There are many different variations; the deceased may be present in a ceremonial

casket for a visitation and a funeral service, followed by the cremation. If the urn is to be

buried a graveside service may be scheduled at a later date.

If you choose cremation, we strongly recommend that you hold a memorial service

to help you and your loved ones in the healing process.

The fees include professional services, attention to all details including filing of forms with

government offices, preparation of newspaper notices if desired and handling of

floral tributes if any.

These below prices reflect the professional charges and some services, for example, the

Medical Examiner Fee and the crematory fee. Third-party charges, such as obituaries,

death certificates, and anything not listed would be an additional cost.

You may also consider memorial items such as prayer cards, a register book,

a Memorial DVD Tribute, personalized bookmarks, candles, or jewelry.


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Telephone: 412-521-8116 Fax: 412-521-8250

TRADITIONAL FUNERAL SERVICE

PUBLIC VIEWING, RENTAL CASKET, AND CREMATION PACKAGE $3,995.00

This package includes the basic service of the funeral

director and staff, transfer of the deceased to the funeral home within a 20 mile radius, embalming,

ceremonial casket for use at the visitation, dressing and casketing, the use of facilities and staff for one

day of visitation, with a funeral ceremony or services in our funeral home or another facility, hearse for service

if necessary, lead vehicle if necessary, a committal service if desired, a visitor’s register book, prayer cards, thank you cards, a Memorial Tribute DVD, a memorial candle or a crucifix for inside the casket, attention to all details including filing of forms with

government offices, preparation of obituaries and handling of floral tributes. Other items to be considered (Not included in our

fee) would be any/or all cash advances such as the Medical Examiner fee ($50) crematory fee $250), cemetery fees,

newspaper fees, clergy costs, flowers, certified copies of the death certificates ($20 each).


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Telephone: 412-521-8116 Fax: 412-521-8250

PRIVATE VIEWING FOR FAMILY ONLY WITH A RENTAL CASKET,

CREMATION $1,495.00

This package includes the basic services of the funeral

director and staff with minimum preparation of the

deceased. The use of facilities for 30 minutes of a private

viewing, family only, with a rental casket.

This Package includes a rental casket, the Medical Examiner’s Fee ($50), and the Crematory Fee ($250), an urn, and personalized prayer cards. Other items to be considered may include cash advances such as newspaper fees, clergy costs, flowers, certified copies of the death certificates, ($20.00 each).


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Telephone: 412-521-8116 Fax: 412-521-8250

Direct Cremation Options

The term “direct cremation” refers to a cremation without those services in which

the body will be present. It is common for a Memorial or Celebration of Life Service

to take place independently of the cremation itself. The urn may or may not be

present for such services.

VISITATION WITH URN PRESENT AND A MEMORIAL SERVICE $1,495.00

This package includes the basic services of the funeral

director and staff with minimum preparation of the

deceased. The use of facilities for two hours for a public

visitation and or a Funeral Ceremony .

This Package includes theMedical Examiner’s Fee ($50), and the Crematory Fee ($250), an urn, and personalized

prayer cards. Other items to be considered may include cash advances such as newspaper fees, clergy costs, flowers, certified copies of the death certificates, ($20.00 each).

DIRECT / IMMEDIATE CREMATION $995.00

This package includes the basic service of the funeral director and staff. Our facilities to hold the deceased for up to 24 hours as ordered by the State Board of Funeral Directors. The Medical Examiner’s fee ($50) and the Crematory fee($250) is included.

Other items to be considered may include personalized memorial

items such as a DVD Memorial Tribute, any/or all cash advances such

as newspaper fees, and certified copies of the death certificates ($20.00).


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Telephone: 412-521-8116 Fax: 412-521-8250

Other items to consider if not included in the above Traditional Service or Cremation Service Packages

Professional Services:

Services of Funeral Director, for Church Services, Memorial Services, or Cemetery

Services where no Package Plan has been selected or another funeral home has completed some

of the arrangements. $200 per hour

Embalming Except in certain special cases, embalming is not required by law. Embalming may

be necessary however, if final disposition does not take place within 24 hours or if there is to be a

public viewing of the deceased. This fee includes the use of the Preparation room ($100), bathing

$75), dressing (dressing) ($75), and the positioning of the deceased in a casket or alternative

container $75). $1,200

Restorative Art Work for viewing purposes $200 per hour

Autopsy Restoration $200 per hour

Plastic coveralls, additional chemicals $125

Hairdressing- basic $60

Use of Funeral Home and Parking Facilities $200 per four hours

Automotive Equipment: within a 25 mile radius, one way, extra mileage, each vehicle $2.50 per mile

Transfer of deceased to / from the funeral home $300 / $300

Clergy car / Processional Lead car , Family car $250 / $250 / $250

Limousine $350

Service car / Utility van $150 per hour


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Telephone: 412-521-8116 Fax: 412-521-8250

Merchandise: Range of prices: A complete price list will be provided for review at the funeral

home.

Caskets $ 855.00 to $6,150

Ceremonial Rental Casket $800.00

Outer Burial Containers $1,095 to $16, 995

Cremation urns $89 and up

Burial clothing $150 and up

Thank you cards, per 25 $15

Register book $25

Cross / Crucifix $60

Prayer cards, per 80 $60 Additional cards, per 80 $40

Day of Service Programs. Per 80 $125 Additional programs, per 80 $100

Memorial DVD Tribute $ 95.00 Additional copies, $15 each

Memorial candles $ 40

Art Glass, Cremains in Glass $150 and up

Cremation Jewelry Keepsakes $45 and up

HD Life Portrait Porcelain Tiles $99 and up


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Telephone: 412-521-8116 Fax: 412-521-8250

GENERAL PRICE LIST CASKETS OCTOBER 15, 2019

Hardwood Caskets

Known for their natural warmth and beauty Hand crafted like fine furniture.

Each have their own unique grain pattern. No two caskets are made alike.

Washington, Solid Cherry, High Gloss, Medium Stain, Tufted cap panel,

Almond Velvet interior. Price: $3,795.00

Oak Manor, HARDWOOD, Solid American Oak, Satin finish, Light Stain,

Tufted cap panel, Almond Velvet interior, Price: $3,375.00

Pieta, HARDWOOD, Solid Poplar, Satin finish, Medium stain, Sunburst cap panel,

Almond Velvet interior, Price: $2,595.00

Hilton Cherry, HARDWOOD, Solid Poplar, High Gloss, Dark Cherry stain, Tufted cap panel,

Eggshell Velvet interior, Price: $2, 395.00


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Telephone: 412-521-8116 Fax: 412-521-8250

Stouffer, HARDWOOD Pennsylvania Veneer Poplar, Light Oak satin finish

Piped cap panel, Soft White Velvet interior, Price: $1,995.00

Copper Caskets PREMIUM, Naturally Non-rusting (Will never rust nor corrode)

Finest material and construction. All Copper caskets have a rubber gasket

Agean. Solid Copper, Brushed finish, Antique Bronze exterior, Tufted cap panel

Almond Velvet Interior. Price: $6.150.00

Precious Lilac, Solid Copper, Brushed finish, Lilac exterior, Roses in Cap panel,

Pink Velvet Interior. Price: $6,150.00

Stainless Steel Caskets

PREMIUM, Rust Resistant. All Stainless Steel caskets have a rubber gasket

Moonstone Stainless Steel, PREMIUM. Brushed Finish, Gunmetal exterior,

Tufted cap panel, White Velvet interior. Price: $3,525.00


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Telephone: 412-521-8116 Fax: 412-521-8250

Stainless Rose, PREMIUM, Ice Rose Exterior, Brushed Finish, Roses in cap panel,

Pink Velvet interior. $3,525.00

Basic Steel Caskets 18 gauge (Medium thickness) 20 gauge (Thinnest Steel)

Ellington 20-gauge Steel, BASIC STEEL. OVERSIZE. Silver exterior, White Crepe interior,

Sunburst cap panel, non-gasketed. This casket gives additional room if necessary,

two interior sizes offered: Both caskets will fit into a single grave and a

#40 Outer Burial Container.

33 interior inches Price: $3,250.00 36 interior inches: Price $3,495.00

Pieta Ebony, BASIC STEEL, 18 Gauge Steel, Brushed Finish. Ebony exterior,

Piped Cap Panel, Almond Velvet Interior, Price: $3,150.00

Pieta Topaz, BASIC STEEL, 18 Gauge Steel, Brushed finish, Autumn Haze exterior, Piped Cap Panel

Almond Velvet Interior Price: $3,150.00

Freedom, BASIC STEEL, 18 Gauge Steel, Midnight Blue Finish,

Blue Wool Interior , Price: $2,895.00

Midnight Blue, BASIC STEEL, 18 Gauge Steel, Ice Blue exterior,

Rosetan Bellaire Interior interior, Price: $2,895.00

Princess Rose, BASIC STEEL, 18 Gauge Steel, Ice Rose exterior, Piped / Rose cap panel,

Pink Velvet interior, Price: $2,750.00


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Telephone: 412-521-8116 Fax: 412-521-8250

Ivory Rose, BASIC STEEL, 18 Gauge Steel, Antique White Exterior, Flowers in cap panel,

Pink Velvet interior, Price: $2,250.00

Lawrence, BASIC STEEL, 20 Gage metal, Basic Steel, Six colors, Velvet Interiors,

Lawrence Silver, Lawrence White/Gold, Lawrence Orchid, Lawrence Metallic Blue,

Lawrence Candy Apple, Lawrence Bronze

Nine different cap panels, 40 different hardware decals Price: $2,150.00

Going Home, BASIC STEEL, 18 Gauge Steel, Spruce Blue exterior, Going Home Cap Panel

Blue Crepe Interior Price: $1,850.00

Sierra Devon, BASIC STEEL, 20 gauge metal, Four colors,- Blue, Silver, White, Coppertone,

non-gasketed, Crepe interior Price: $1,427.00

Economy, BASIC STEEL, ECONOMY

20-gauge metal, Two colors- Coppertone, Silvertone, Crepe interior,

non-gasketed, Price: $1, 055.00

Cloth covered, ECONOMY, These caskets are made of flakeboard or particle board.

Blue Doeskin Tapestry exterior, White Satin Interior, Price: $855.00


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Telephone: 412-521-8116 Fax: 412-521-8250

GENERAL PRICE LIST

OUTER BURIAL CONTAINERS - BURIAL VAULTS

OCTOBER 15, 2019

The Wilbert Bronze

Precise engineering and more than 40 hours of hand-crafted

detail produce Wilbert’s supreme and only triple-reinforced burial

vault. • Ultimate triple-reinforced protection • Cover and base

reinforced with durable bronze alloy • Interior reinforced with

high-impact plastic • Exterior base completely encased in high-

impact plastic • May be personalized with special images,

emblems or personal photos Price: $16, 995.00

Bronze Triune

• Finest double-reinforced Wilbert burial vault • High-strength

concrete with bronze and high-impact plastic • Lustrous bronze

carapace • May be personalized with special images, emblems or

personal photos Price: $5,695.00


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Telephone: 412-521-8116 Fax: 412-521-8250

Copper Triune

• Double-reinforced burial vault • High-strength concrete with

copper and high-impact plastic • Rich copper carapace • May be

personalized with special images, emblems or personal photos

Price: $4,695.00

Stainless Steel Triune • Mid-line burial vault • Cover and base double-reinforced with

strong, corrosion-resistant stainless steel and high-impact plastic

• Brilliant stainless-steel carapace • May be personalized with

special images, emblems or personal photos Price: $3,495.00


http://www.giffinfuneralhome.com/resources/merchandise#list-layout

http://www.giffinfuneralhome.com/resources/merchandise#table-layout

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Telephone: 412-521-8116 Fax: 412-521-8250

Cameo Rose Triune

• Mid-line burial vault • Cover and base double-reinforced with

strong, corrosion-resistant stainless steel and high-impact

plastic • Brushed stainless steel carapace • Soft white finish with

pink accents and sculpted pink rose • May be personalized with

special images, emblems or personal photos Price: $3,495.00

Veteran Triune

• Mid-line burial vault • Cover and base double-reinforced with

strong, corrosion-resistant stainless steel and high-impact

plastic • Brushed stainless steel carapace • Includes branch-

specific military emblems and customized U.S. flag nameplate

• May be personalized with special images, emblems or

personal photos Price: $3,495.00

White Venetian

• Finest single-reinforced burial vault • High-strength concrete

with high-impact plastic and a reinforced cover and base • Rich

look of polished marble • Personalization choices available

Price: $2,295.00


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Telephone: 412-521-8116 Fax: 412-521-8250

Continental • Single-reinforced burial vault • Durable concrete exterior

with a plastic-reinforced cover and base

Price: $1,895.00

Monticello • Single-reinforced burial vault • Concrete exterior with a

plastic-reinforced cover and base

Price: $1,595.00


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Telephone: 412-521-8116 Fax: 412-521-8250

Salute

• Entry level single-reinforced burial vault • Concrete exterior

with a plastic-reinforced cover and base • Exclusive Salute

Emblem for veterans Price: $1,595.00

HARLEY

Standard Burial Vault, Top Sealed,

Reinforced-banded lid, No plastic liner

Price: $1,250.00

GRAVE LINER

Concrete cement box,

Satisfies cemetery requirements

Price: $ 1,095.00


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Telephone: 412-521-8116 Fax: 412-521-8250

GENERAL PRICE LIST CREMATION PRODUCTS OCTOBER 15, 2019

MEMORIAL KEEPSAKES

1 Cremation Products and Memorial Keepsakes,

Pet Services


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Telephone: 412-521-8116 Fax: 412-521-8250

CREMATION AUTHORIZATION

Name of Deceased: ________________________________________________________________

Date of Death: ________________ Place of Death: _________________________________

I/ WE the undersigned request and authorize The John D. O’Connor & Son Funeral Home Inc.,

and /or their Agents in accordance with and subject to its rules and regulations, to cremate the

remains of the above named Decedent.

I / We certify and represent that I / we have the right to make such authorization and agree to hold

The John D. O’Connor & Son Funeral Home Inc., harmless from any liability on account of said

authorization and cremation.

The final disposition of the cremated remains are as follows:

____ Will be picked up by myself or my Authorized Representative within 90 days.

If the cremated remains are not picked up within 90 days I further agree that it is my wish to have them disposed of. __________________________________________

____ Will be delivered to______________________________________________________________

by The John D. O’Connor & Son Funeral Home Inc. ____________________________

____ I / We make no claim to the cremated remains and wish to have the cremated remains disposed of in any legal manner. _________________________________ .

Next of Kin / Legal Representative/ Person responsible for Arrangements and Payment for the selected

services as stated on the STATEMENT OF GOODS AND SERVICES.

____________________________________ _____________________________________

Funeral Director / Authorized Agent

Address: ____________________________

City, State, Zip: ______________________ Date: ________________________________

The John D. O’Connor & Son Funeral Home Inc., certifies that the final disposition of the cremated

remains are as follows:


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Telephone: 412-521-8116 Fax: 412-521-8250

DISCLOSURE / DISCLAIMER FORM

Re: _________________________________ Place of Death _______________________________

Date of Death: _______________________ Date of Final Disposition ______________________

The Federal Trade Commission Trade Regulation Rule for “ Funeral Industry Practices” requires certain

disclosures and prohibits misrepresentations. This Disclosure / Disclaimer Form is a check list that we ask

those who we serve to read and sign if responsible for the arrangements.

The John D. O’Connor & Son Funeral Home, Inc. did or did not do the following:

_____ Prior to discussing prices, services or merchandise we were given or shown a

___General Price List, effective on October 19, 2019 (Given)

___Casket Price List effective on October 19, 2019, if a casket was to be selected (Shown)

___Outer Burial Container Price List effective on October 19, 2019, If one was to be selected

(Shown)

EMBALMING: ___Embalming was not performed Initials ___________

____Embalming was done with my/our permission Initials: __________

We were informed that embalming is not required by law except under certain cases.

• An open casket, public viewing requires embalming.

• We understand that embalming is not required for an immediate burial, a funeral using a

closed casket with a rubber gasket, or if refrigeration is available.

• Direct cremations do not require embalming if the Physician signs the Death Certificate, the

Next of Kin signs the Cremation Authorization Form, The Medical Examineer authorizes the

cremation, and the deceased can be delivered to the crematory all within the first 24 hours of

death. After 24 hours, embalming may be the only option available if no refrigeration is available.

CASKET:

• We were told that no law requires a casket for final disposition or direct cremation. An unfinished

wooden box or a cardboard cremation container with plastic wares may suffice. The crematory does

require a wooden tray for over weight cases of 200 pounds.


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Telephone: 412-521-8116 Fax: 412-521-8250

OUTER BURIAL CONTAINER: We were told that no law requires the purchase of an outer burial

container (we understand that it is required by most cemeteries) or any of the funeral goods or services we

selected except as set forth on the Statement of Funeral Goods and Services (Agreement Form).

* No claims were made by the John D. O’Connor & Son Funeral Home Staff as to the

merchandise or other offerings (embalming, casket, outer burial container) would delay

the decomposition of the remains for a long term or indefinite time, or would protect the

body from grave site substances. No representations or warranties were made about the

protective features of caskets or outer burial containers other than those made by the manufacture.

The only warranties, expressed or implied, granted in connection with good sold with the funeral

service arranged for were the expressed written warranties, if any, extended by the manufactures

thereof. No other warranties of merchandising fitness or a particular purpose were extended.

* We were not told that the amount of each cash advance item was the cost to the funeral

home. We were told the cost may be different due to volume or discount or other

professional and trade customs.

____________________________________________

John D. O’Connor & Son FH, Inc.

_____________________________________________

Person responsible for final arrangements and the financial obligations agreed to within The

Statement of Goods and Services.

Date _______________________________


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Telephone: 412-521-8116 Fax: 412-521-8250

DATE: _ ___________________________________________________________

TIME: _____________________________________________________________

TO: ________________________________________________________________

FROM: Patrick Vereb 412-973-8568

John D. O'Connor and Son Funeral Home, Inc. 412-521-8116

Eternity Pet Memorial 412-421-6910

RE:___ ______________________________________________________________

PAGES: ________________________________ (INCLUDING COVER SHEET)

COMMENTS:

If you did not receive all of the pages or there was a problem with transmission,

please notify us at 412-521-8116


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Telephone: 412-521-8116 Fax: 412-521-8250

RELEASE OF HUMAN REMAINS TO

The John D. O’Connor & Son Funeral Home Inc.,

Name of Deceased: ____________________________________________________________

Date of Death: ______________________________________________________________

Place of Death: _____________________________________________________

Next of Kin / Legal Representative/ Person responsible for Arrangements:

________________________________ Date: _________________________

The John D. O’Connor & Son Funeral Home Inc., including its designated agents,

do hereby certify that we are authorized to receive and transport the remains of the above

named decedent.

_______________________________ Date: _______________________

Funeral Director / Authorized Agent


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Telephone: 412-521-8116 Fax: 412-521-8250

AUTHORIZATION FOR RELEASE AND EMBALMING IF NECESSARY

I,____________________________________________, do hereby release the remains

of ___________________________________________to the JOHN D. O’CONNOR

& SON FUNERAL HOME INC. and/or its agents and authorize the funeral home and/or

its agents to care for, embalm and otherwise prepare the remains for burial and/or viewing

or other disposition using whatever means they deem necessary.

Embalming provides for sanitation and disinfection as well as temporary preservation and

restoration of the deceased. After final disposition, including interment, entombment or

cremation the JOHN D. O’CONNOR & SON FUNERAL HOME INC. has no control

over events or conditions that may occur and is hereby released from any and all liabilities

resulting from such events or conditions as well as any liability for the continued

preservation of the deceased.

I hereby represent that I am of the same and nearest degree of relationship to the

deceased and am legally authorized or charged with the responsibility for the burial

and/or other disposition and hold myself responsible for the payment of any and all

charges as selected on the STATEMENT OF GOODS AND SERVICES.

______________________________ ____________________ Date __________

Signature Relationship

If the authorization for release and embalming is granted by telephone complete the

following:

Family member________________________Relationship__________________

Date__________________________ Time_______________________

Funeral Home Staff Member: ______________________________________


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Telephone: 412-521-8116 Fax: 412-521-8250


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Telephone: 412-521-8116 Fax: 412-521-8250


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