NOTICE: THIS IS A LEGAL DOCUMENT. IT CONTAINS IMPORTANT PROVISIONS CONCERNING ALKALINE HYDROLYSIS. THE PROCESS IS IRREVERSIBLE AND FINAL. READ THIS DOCUMENT CAREFULLY BEFORE SIGNING.

B. If Authorizing Agent(s) is/are aware of any other living person(s) with equal right to that of Authorizing Agent(s), Authorizing Agent(s) hereby certify, warrant, and represent that Authorizing Agent(s) has (have) either disclosed the location of all living persons with equal right to that of Authorizing Agent(s), as set forth in G.S. 90-210.124, or does (do) not know the location of any other living person with an equal right to that of AuthorizingAgent(s).

C. If Decedent’s hydrolysis involves a licensed funeral establishment or individual licensed pursuant to G.S. 90-210.25(a2)(2):

FORM BFS-59A – Standard Alkaline Hydrolysis Authorization Form (Rev. 09/2023)

D. If Decedent’s hydrolysis does not involve a funeral establishment or individual licensed pursuant to G.S. 90-210.25(a2)(2):

G. Hydrolysis begins with the placement of the hydrolysis container into the hydrolysis chamber where it will be subjected to pressurized, heated water and chemical solutions. I/We hereby authorize Hydrolysis Licensee to hydrolyze Decedent’s human remains. At the conclusion of the hydrolysis process, the hydrolyzed remains are removed from the hydrolysis chamber and allowed to cool and dry before pulverization. The process results in considerably more remains being returned than cremation and may require a larger initial container or urn than would be necessary for cremation.

H. Hydrolyzed remains are processed or pulverized to permit their placement in an initial container or other suitable container. I/We hereby authorize Hydrolysis Licensee to process and/or pulverize Decedent’s hydrolyzed remains. Unless another container type is purchased for the hydrolyzed remains of Decedent, Hydrolysis Licensee will place the hydrolyzed remains in an initial container that may not be recommended for any type of shipment. In the event the capacity of the initial container or any other container is insufficient to accommodate all of the hydrolyzed remains of Decedent, a separate initial container will be used and returned to the person(s) designated in ParagraphL of this Authorization.

I. Unless specifically prohibited by the manufacturer thereof, human remains may be hydrolyzed without first removing a pacemaker, other material, or implanted device(s). Hydrolysis Licensee will not; however, hydrolyze any human remains which contain any type of hazardous implanted mechanical device. In the event the remains of Decedent do contain such a device, Authorizing Agent(s) hereby authorize and instruct Funeral Provider or when not applicable, Hydrolysis License, its agents and employees to remove any and all hazardous mechanical devices from Decedent prior to the hydrolysis process. Any such removal must be carried out accordance to the manufacturer’s guidelines and any applicable law or rule.

Acknowledgement: By initialing below, I/We hereby acknowledge each item set forth in Sections D through J above.

FORM BFS-59A – Standard Alkaline Hydrolysis Authorization Form (Rev. 09/2023)

K. If no final disposition is given, the hydrolyzed remains of Decedent will be held by Funeral Provider or if not applicable, Hydrolysis Licensee, for 30 days before they are disposed of, unless the hydrolyzed remains of Decedent are received from Funeral Provider or if not applicable, Hydrolysis Licensee, prior to that time, in person, by Authorizing Agent(s) or his/her/their designee.

L. I/We authorize Funeral Provider or if not applicable, Hydrolysis Licensee, to return the hydrolyzed remains of Decedent according to my/our directive(s) below. I/We understand that the services and obligations of Hydrolysis Licensee shall be fulfilled when the hydrolyzed remains of Decedent are returned to the possession and custody of Funeral Provider, if applicable. I/We hereby authorize Funeral Provider or if not applicable, Hydrolysis Licensee, to arrange for the disposition of the hydrolyzed remains of Decedent as follows (complete appropriatedisposition):

M. Authorizing Agent(s) understand(s) that after this Standard Alkaline Hydrolysis Authorization Form is executed, Authorizing Agent(s) can only revoke the authorization and instruct Funeral Provider and/or Hydrolysis Licensee to cancel the hydrolysis and to release or deliver Decedent’s remains to another funeral provider and/or hydrolysis licensee by providing such instructions to Hydrolysis Licensee in writing prior to the commencement of hydrolysis. Hydrolysis Licensee shall honor these instructions provided that it receives such instructions prior to commencement of the hydrolysis of Decedent's human remains.

N. Pursuant to G.S. 90-210.125(c), a hydrolysis licensee shall have the legal right to hydrolyze human remains upon the receipt of a hydrolysis authorization form signed by an authorizing agent. There shall be no liability for a hydrolysis licensee that hydrolyzes human remains pursuant to such authorization, or that releases or disposes of the hydrolyzed remains pursuant to such authorization, except for such hydrolysis licensee’s gross negligence, provided that thehydrolysis licensee performs such functions in compliance with the provisions of NC General Statutes Chapter 90, Article 13F. There shall be no liability for a funeral establishment or individual licensed pursuant to G.S. 90-210.25(a2)(2) or licensee thereof that causes a hydrolysis licensee to hydrolyze human remains pursuant to such authorization, except for gross negligence, provided that the funeral establishment or individual licensed pursuant to G.S. 90-210.25(a2)(2) and licensee thereof and hydrolysis license perform their respective functions in compliance with the provisions of G.S. 90-210.125.

Acknowledgement: By initialing below, I/We hereby acknowledge each item set forth in Sections K through N above.

FORM BFS-59A – Standard Alkaline Hydrolysis Authorization Form (Rev. 09/2023)

O. If this Standard Alkaline Hydrolysis Authorization Form is being executed on a preneed basis: 1. By placing his or her initials in the appropriate line, Authorizing Agent indicates his or her election of saidoption:

2. Authorizing Agent may specify in writing religious practices that conflict with Article 13 of Chapter 90 of the North Carolina General Statutes. Funeral Provider and/or Hydrolysis Licensee shall observe these religious practices except where they interfere with: (i) hydrolyzation in a licensed hydrolysis provider as specified under G.S. 90-210.136 or (ii) the required documentation and recordkeeping.

By executing this Standard Alkaline Hydrolysis Authorization Form, as Authorizing Agent(s), the undersigned warrant that all representations and statements, except for Sections C or D and Sections I, if that information is unknown to Authorizing Agent(s), contained on this form are true and correct, that these statements were made to induce Hydrolysis Licensee to hydrolyze the human remains of the Decedent, and that the undersigned have read and understand the provisions contained on this form.

FORM BFS-59A – Standard Alkaline Hydrolysis Authorization Form (Rev. 09/2023)

By executing this authorization form as a funeral director or funeral service licensee and an agent / employee of Funeral Provider, I warrant to the best of my knowledge that (1) Funeral Provider was responsible for making arrangements with Authorizing Agent(s) for the hydrolysis of Decedent and that I have reviewed this authorization form with Authorizing Agent (s); (2) that no employee of Funeral Provider has any knowledge or information that would lead it to believe that any of the answers provided on this form, by Authorizing Agent(s), are incorrect; (3) that the human remains delivered to Hydrolysis Licensee and represented as the human remains specified on this form are in fact the human remains that were identified to Funeral Provideras Decedent; and (4) that Funeral Provider obtained all necessary permits authorizing the hydrolysis of Decedent, including approval from the Office of the Chief Medical Examiner, if required. I understand that failureto complete this authorization in its entirety and other required documentation will result in the delay of the hydrolysis of Decedent.