The Carlson Company LLC
10343 Federal Blvd. Suite J- 401,Westminster, CO 80260
Cremains Acknowledgement Form
Print This Form
Please review, print out, and complete this form. This form must be submitted with your cremains test sample.
Thank you for your assistance. The Carlson Company, LLC Online at www.TheCarlsonCompany.net
Identity of the cremains sample. Please print the following information
Name _________________________________________________________________________________________ Age _________
Official cause of Death? _______________________________________________________________________________________
Sample Submitter's Information – Please print the following:
City ___________________________________ State __________________ Zip Code: ________________________________
As the cremains test sample submitter I acknowledge that;*
- I am requesting that The Carlson Company
LLC assist me with certified lab cremains testing related to the DNA
and/or Toxicology of the deceased.
- Cremains testing will be conducted as a last resort to bring closure to the concerns I have regarding my loved one's passing.
- I have been advised by the Carlson
Company LLC to seek out other alternative premortem or postmortem test
samples. Reminder, alternative test samples may be available from the
Medical Examiner's office who signed the Death Certificate, through
autopsy, or from a hospital, hospice, or doctor who may have treated the
deceased. Occasionally, hair strand samples are collected from the
deceased prior to cremation as a keepsake.
- I, as the sample submitter, state that
to my knowledge, no other suitable test samples, premortem or
postmortem, belonging to the deceased are available or accessible for
- Cremains testing is considered to be a
50/50 testing proposition. The Carlson Company LLC or its affiliated DNA
or Toxicology lab does not offer any guarantee of successful cremains
- The integrity of the cremains testing
sample that I submit for testing is always the determining factor for
the success or failure of any type of testing evaluation.
- Cremains testing fees are due and
payable with the test sample submission. No portion of the cremains
testing fees are refundable.
- When the testing and evaluation have
been completed and a certified test report has been provided to the
sample submitter we will consider our obligation fulfilled.
As the sample submitter I have reviewed and accept the above acknowledgements.
Sample submitter's name (print) ________________________________________________________________________________
Signature _____________________________________________________________________________ Date _________________________