The Carlson Company LLC

10343 Federal Blvd. Suite J- 401,Westminster, CO 80260

Cremains Acknowledgement Form

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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:

Name __________________________________________________________________________________________________

Address _____________________________________________________________________________________________________

City ___________________________________ State __________________ Zip Code: ________________________________

Email ________________________________________________________________________

Acknowledgements

As the cremains test sample submitter I acknowledge that;*

  1. 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.
  2. Cremains testing will be conducted as a last resort to bring closure to the concerns I have regarding my loved one's passing.
  3. 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.
  4. 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 testing.
  5. 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 testing result.
  6. 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.
  7. Cremains testing fees are due and payable with the test sample submission. No portion of the cremains testing fees are refundable.
  8. 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 _________________________