New Zealand Gazette – 1928 – No. 81

Page 3097

✨ Cremation Regulations Forms



Oct. 25.]

THE NEW ZEALAND GAZETTE

3097

  1. Did the deceased leave any written
    direction as to the mode of disposal of his
    [or her] remains; and, if so, what ?
  2. Have the near relatives of the de-
    ceased been informed of the proposed cre-
    mation?
    (The term “near relative” as here
    used includes widow, widower, parents,
    children above the age of sixteen, and
    any other relative usually residing with
    the deceased.)
  3. Has any near relative of the de-
    ceased expressed any objection to the
    proposed cremation? If so, on what
    ground?
  4. What was the date and hour of the
    death of the deceased?
  5. What was the place where deceased
    died. [Give address, and say whether own
    residence, lodgings, hotel, hospital, nursing
    home, &c.]
  6. Do you know or have you any
    reason to suspect that the death of the
    deceased was due, directly or indirectly,
    to—
    (a) Violence;
    (b) Poison;
    (c) Privation or neglect;
    (d) Illegal operation.
  7. Do you know any reason whatever
    for supposing that an examination of the
    remains of the deceased may be desirable?
  8. Give name and address of the ordi-
    nary medical attendant of the deceased.
  9. Give names and addresses of all
    the medical practitioners who attended
    deceased during his [or her] last illness.
    (The deceased was a member of the
    religious denomination known as ,
    and the tenets of the said denomina-
    tion require the burning of the body
    to be carried out as a religious rite,
    otherwise than in a crematorium.)
    I hereby certify, with a view to procuring the cremation of the remains of
    the above-named deceased, that all the particulars stated above are true, and
    that to the best of my knowledge and belief, no material particular has been
    omitted.
    Signed at , the day of . [Signature.]
    Witness to signature--
    Name:
    Occupation:
    Address:

FORM B.

THE CREMATION REGULATIONS, 1928.
Certificate of Medical Attendant.

I AM informed that application is about to be made for the cremation of the
remains of
[Name of deceased.]
[Address.]
[Occupation.]
Having attended the deceased before, and seen and identified the body after
death, I give the following answers to the questions set out below:—

  1. On what date and at what hour did
    he [or she] die?
  2. What was the place where the de-
    ceased died? [Give address, and say whe-
    ther own residence, lodgings, hotel, hospital,
    nursing home, &c.]
  3. Are you a relative of the deceased?
    If so, state the relationship.
  4. Have you, so far as you are aware,
    any pecuniary interest in the death of the
    deceased?
  5. Were you the ordinary medical
    attendant of the deceased? If so, for
    how long?
  6. Did you attend the deceased during
    his [or her] last illness? If so, for how
    long?
  7. When did you last see the deceased
    alive? [Say how many hours or days
    before death.]
  8. How soon after death did you see
    the body, and what examination of it did
    you make?


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✨ LLM interpretation of page content

🏥 Regulations as to Cremation (continued from previous page)

🏥 Health & Social Welfare
16 October 1928
Cremation, Regulations, Medical Referee, Duties, Certificates, Disposal of Ashes, Records, Register

🏥 Certificate of Medical Attendant for Cremation

🏥 Health & Social Welfare
Cremation, Medical Certificate, Death, Medical Attendant