Order Direct Cremation - Rise Cremation

Service Location

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Zip Code * Services available throughout Utah

Current Status

Has the death already occurred? *

Where is the deceased currently located? *

Facility Name *

Facility Street Address *

Location within residence Please specify where in the residence the deceased is located

Deceased Information

First Name *

Middle Name

Last Name *

Also Known As (AKAs or Aliases)

Date of Birth *

Date of Death *

Time of Death Leave blank if unknown

Time of death unknown

Approximate Height *

Approximate Weight * Note: A $200 surcharge applies for weights over 250 lbs

City of Birth *

State/Country of Birth *

Sex *

Social Security Number *

Marital Status *

Ever Served in U.S. Armed Forces? *

Highest Level of Education *

Usual Occupation Type of work done during most of working life, even if retired

Kind of Business or Industry

Father's Full Name *

Mother's Full Name Prior to First Marriage *

Residence Information

Street Address *

City/Town *

County *

State *

Zip Code *

Was residence inside city limits? *

Race and Ethnicity

Is the deceased of Hispanic origin? *

Contact Person (Informant / Next of Kin)

First Name *

Last Name *

Relationship to Deceased *

Phone Number *

Email Address *

Mailing Address

Address where ashes should be returned

Street Address *

City *

State *

Zip Code *

Additional Information

Was the deceased on Hospice? *

Was the deceased pregnant at the time of death or within the past year? * Required by Utah for all female decedents — for death certificate purposes only

Did the deceased have any communicable diseases? * Examples: COVID-19, Tuberculosis, Hepatitis, MRSA, HIV/AIDS, etc.

Please specify the communicable disease(s) *

Special Instructions (Optional)

Deceased had a pacemaker or other implanted medical device Important: The following devices must be removed before cremation and require special handling:

Pacemakers & Defibrillators: These battery-powered devices can explode during cremation, potentially damaging equipment and causing injury.

Insulin Pumps: Contains batteries and pressurized components that must be safely removed.

Neurostimulators: Spinal cord and deep brain stimulators contain batteries that pose explosion risks.

Breast Implants: Silicone and saline implants should be noted as they may require special handling during cremation.

Radioactive Implants: Some cancer treatment implants contain radioactive materials requiring special disposal.

Our partner funeral homes will professionally remove these devices at no additional charge. Please check this box if any of these devices are present.

Please select the specific device(s):

Pacemaker

Implantable Cardioverter Defibrillator (ICD)

Insulin Pump

Neurostimulator (Spinal Cord or Deep Brain)

Breast Implants

Radioactive Implant (Cancer Treatment)

Device location and additional details (if known) Please provide any information about device location, type, or brand that may help our partner funeral homes.

Death Certificate Copies

Number of Death Certificate Copies Needed Utah state fee: First copy $30, each additional copy $10.

I agree to the Terms of Service and authorize this cremation

I certify that I have the legal authority to authorize this cremation

I acknowledge that if next of kin is not present for identification and signatures when funeral professionals are present at time of receiving the deceased into their care, additional arrangements or fees may be required

Direct Cremation Order