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Allen Dave Funeral Directors and Cremation Tribute Center (Houston)2103 Cypress Landing, Houston, Texas 77090713-480-2966Allen Dave Funeral Home (Brenham)407 Burleson Street, Brenham, Texas 77833979-830-5510Allen Dave Funeral Home & Crematorium (Carthage)2107 State Hwy 149, Carthage, Texas 75633903-263-0003FTC Disclosure/Disclaimer FormThe Federal Trade Commission’s Funeral Industry Practices Rule requires certain disclosures and prohibitsmisrepresentations. This Disclosure/Disclaimer Form is a checklist we ask those we serve to read and sign if, during thefuneral arrangements, our firm complies with the following:Deceased Name: DOD: Date:NOK INITIAL1. The undersigned received a “General Price List”, effective October 1, 2020, which is our CASH PRICEfor Services and Products & our “Facts about Funerals Brochure” by the Texas Funeral ServiceCommission / Louisiana State Board of Embalmers and Funeral Directors and prior to discussing prices,services or merchandise.2. The undersigned received, “Casket Price List”, effective October 1, 2020,prior to viewing or discussing prices of caskets.3. The undersigned received an “Outer Burial Container Price List”, effective October 1, 2020, prior toviewing or discussing prices of our outer burial containers.4. The undersigned understands that embalming is not required by law and if, embalming was provided, itwas due to a rule, requirement or by the undersigned’s or other family member permission.5. Warranties: The only warranties, expressed or implied, granted in connection with goods sold with thisfuneral service are the express written warranties, if any, extended by the manufacturers thereof. Noother warranties and no warranties of merchantability or fitness for a particular purpose are extended byseller.6. The undersigned received the funeral home, “Twelve Payment Options & Payment Policy”.7. Payment for Services and Merchandise is expected prior to the services rendered.12 Method of Payments Must Be Secured Three Days Prior to Any Scheduled Services.All Insurance documents must be verified & approved three days prior to any services.8. 100% Full Payment is due with Certified Funds are due at 12:00pm Three Days Prior to Services.Day: Date: Other Time:Name: Date:Name: Date:Funeral Director:Date:1 Page10/1/2020
Allen Dave Funeral Directors and Cremation Tribute Center (Houston)2103 Cypress Landing, Houston, Texas 77090713-480-2966Allen Dave Funeral Home (Brenham)407 Burleson Street, Brenham, Texas 77833979-830-5510Allen Dave Funeral Home & Crematorium (Carthage)2107 State Hwy 149, Carthage, Texas 75633903-263-0003FTC Disclosure/Disclaimer FormThe Federal Trade Commission’s Funeral Industry Practices Rule requires certain disclosures and prohibitsmisrepresentations. This Disclosure/Disclaimer Form is a checklist we ask those we serve to read and sign if,during the funeral arrangements, our firm complies with the following:Deceased Name: DOD: Date:NOK INITIAL1. The undersigned received a “General Price List”, effective October 01, 2020, which is our CASH PRICE forServices and Products & our “Facts about Funerals Brochure” by the Texas Funeral Service Commission/ Louisiana State Board of Embalmers and Funeral Directors and prior to discussing prices, services ormerchandise.2. The undersigned received, “Casket Price List”, effective October 1, 2020,prior to viewing or discussing prices of caskets.3. The undersigned received an “Outer Burial Container Price List”, effective October 1, 2020, prior toviewing or discussing prices of our outer burial containers4. The undersigned understands that embalming is not required by law and if, embalming was provided, itwas due to a rule, requirement or by the undersigned’s or other family member permission.5. Warranties: The only warranties, expressed or implied, granted in connection with goods sold with thisfuneral service are the express written warranties, if any, extended by the manufacturers thereof. Noother warranties and no warranties of merchantability or fitness for a particular purpose are extended byseller.6. The undersigned received the funeral home, “Twelve Payment Options & Payment Policy”.7. Payment for Services and Merchandise is expected prior to the services rendered.12 Method of Payments Must Be Secured Three Days Prior to Any Scheduled Services.All Insurance documents must be verified & approved three days prior to any services.8. 100% Full Payment is due with Certified Funds is due at 12:00pm Three Days Prior to Services.Day: Date: Other Time:Name: Date:Name: Date:Funeral Director:Date:2 Page10/1/2020
GENERAL PRICE LISTThese prices are effectiveAs of October 1, 2020You may choose only the items you desire. If you are charged for items you did not specificallyrequest, we will explain the reason for the charges on the written memorandum. Please note thatthere may be charges for items such as: Death Certificates, Flowers, Cemetery Fees, NewspaperNotices or other Products & Services.PRICES SUBJECT TO CHANGE WITHOUT NOTICETO HELP YOU UNDERSTANDIt is your right and our desire that you have as much information as possible regarding the cost of services thatwe offer. The most significant factors determining cost is the time spent by our personnel and the use offuneral home facilities. Personnel and facilities must be available 24 hours a day, every day of the year. Muchof what we do is apparent, and some is not. Traditions, social customs, personal feelings, tastes, and amultitude of other factors affect each funeral. Our services must conform to each family’s personal wishes andreligious, emotional and financial needs.Our fixed overhead expenses are our monthly bills totaled for the year and divided by the number of servicesplanned each year and based on the type of service we provide. Our overhead expenses include taxes,employee salaries, building maintenance, capital improvements, stationery supplies, advertising & promotions,utilities, heat, telephone, electricity, yard maintenance, and insurance – fire, theft, liability, automobile, casualty,and workman’s compensation.Meeting with the family to secure vital statistic information, obtain physician’s signature, file the deathcertificate with the registrar of vital statistics in the municipality where the death occurred, obtaining permits forburial or cremation and obtaining as many certified copies of the death certificate as necessary for the family’sneeds. Obtaining obituary information and transmitting that information to all newspapers requested by thefamily. Complete all necessary forms for selected services such as: Veterans Benefits, Social Security forms,and Insurance Claims.Coordinate times of the following services as needed: the clergy, cemetery, crematory, fraternal lodges orother organizations, military honors and others responsible for the final disposition of the deceased. Overseeall aspects of the funeral including conducting the funeral service according to the family’s wishes, staffavailable to supervise the funeral service and / or visitation, give out funeral information to family, associates,florists and friends, use of chapel or equipment for church service as needed, and arranging and care offlowers for best appearance. Complete cost, depreciation, maintenance and operation for our hearses,limousines, sedans, and other vehicles needed for the families we serve.In the event you wish to question any area of our service, you may contact us at your convenience. Ifany of your questions or complaints cannot be resolved, you may also contact:For Texas Residents (Texas Funeral Service Commission, P.O. Box 12217, Capitol Station, Austin,Texas 78711, Telephone number (888) 667-4881, Fax 512-479-5064)3 Page10/1/2020
CASH ADVANCE ITEMSThis represents items that may have to be paid in advance separately. These items include:First Order: Certified copies of the death certificates: Certified copies in Texas are 21.00 for the first copy and 4.00 for each additional copy. Certified copies in Louisiana are 18.00 for first copy and 7.00 each additional.Second Order: Processing fee is 149.00 plus the additional cost of death certificates per state fees.Newspaper notices: The local newspaper provides for a paid obituary which may include biographicalinformation, survivors, service information, memorial contribution information, and a photograph. Wewill also be glad to place obituaries in out-of-town newspapers at your request. These newspapers mayhave a charge, which will be billed to the family.Some other cash advance items are: police escorts, flowers, crematory fees, additional transportation,catering, lodging, honorariums and other products and services.PRE-ARRANGEMENT & PRE-PAID FUNERAL PLANSAllen Dave Funeral Homes & Crematorium offers two types of pre-arrangement plans. You may prepayfor the services in advance which freezes the cost on the items you selected. The cost will neverchange. You may also pre-arrange the services you desire before the death takes place and not payanything in advance. In this case the cost may change in the future.OUR PAYMENT POLICYTo lose someone you love is a devastating human experience. It can be traumatic and seriously impactone’s judgment. Therefore, it is important to be realistic with respect to funeral expenditure. We do notwant your choices to be more than is affordable nor less than you would like to arrange. What isimportant is that arrangements are kept within your wishes and budget. We believe in the recognitionand meaningful celebration of a life that has been lived and will assist in arranging an appropriateservice to meet your individual needs.ALL PRICES STATED ARE BASED ON CASH & BANK CERITIFED FUNDSPLUS, TEN OTHER PAYMENT OPTIONSFor your convenience we accept ten payment options including (1) Cash, (2) PayPal 3%, (3) Visa3%, (4) MasterCard 3%, (5) Discover 3% (6) American Express 3% (7) Cash App (8) Check(9) Verifiable Irrevocable Insurance Assignment for a convenience fee of 6% Bank Feeprocessed by Lincoln Financial Factoring, LLC), (10) Advance payment by a forwarding funeralhome, 11) Advance payment by a receiving funeral home, and (12) Preneed funeral fund fromanother funeral home.ALL SERVICES ARE PENDING UNTIL PAID OR APPROVED FOR PAYMENT.Payment for Services and Merchandise is expected prior to the services rendered.12 Method of Payments — Secured 72 hours prior to Any Scheduled Services.NO PERSONAL CHECKS WITHIN 72 HOURS OF SERVICES. NO EXCEPTIONS!ALL INSURANCE DOCUMENTS MUST BE COMPLETED & VERIFIED 3 DAYS PRIOR TO SERVICES!4 Page10/1/2020
State of Texas Vital RecordsExpedited Death Certificate ProcessingCharge 150.00(7-10 Business Days After Doctor HasSigned the Death Certificate)QuantityPriceNon-Expedited DeliveryNo Additional Charge14-30 Days After the Doctor has Signed DeathCertificateQuantityPrice1 51.001 21.002 55.002 25.003 59.003 29.004 63.004 33.005 67.005 37.006 71.006 41.007 75.007 45.008 79.008 49.009 83.009 53.0010 87.0010 57.0011 91.0011 61.0012 95.0012 65.0013 99.0013 69.0014 103.0014 73.0015 107.0015 77.0016 111.0016 81.0017 115.0017 85.0018 119.0018 89.0019 123.0019 93.0020 127.0020 97.005 Page10/1/2020
State of Louisiana Vital RecordsQuantityPrice1 18.002 25.003 32.004 39.005 46.006 53.007 60.008 67.009 74.0010 81.0011 88.0012 95.0013 102.0014 109.0015 116.0016 123.0017 130.0018 137.0019 144.0020 151.006 Page10/1/2020
Allen Dave Funeral Directors and Cremation Tribute Center (Houston)2103 Cypress Landing, Houston, Texas 77090713-480-2966Allen Dave Funeral Home (Brenham)407 Burleson Street, Brenham, Texas 77833979-830-5510Allen Dave Funeral Home & Crematorium (Carthage)2107 State Hwy 149, Carthage, Texas 75633903-263-0003GENERAL PRICE LISTThese prices are effective October 1, 2020 and are subject to change without notice.The goods and services shown below are those we can provide to our customers. You may chooseonly the items you desire. However, any funeral arrangements you select will include a charge for ourbasic services and overhead. If legal or other requirements mean you must buy any items you did notspecifically ask for, we will explain the reason in writing on the statement we provide describing thefuneral goods and services you selected.PROFESSIONAL SERVICESBASIC SERVICES OF FUNERAL DIRECTOR, STAFF & OVERHEAD 2,895.00 **This fee for our basic services and overhead will be added to the total cost of the funeral arrangementsyou select. (This fee is already in our charge for direct cremation, immediate burials, and forwarding orreceiving remains.) Sunday 3,395.00 and Federal Holiday are 3,895.001st Hour Consultation Fee is 500 included into total overhead cost of 2895 billed separate when familyterminates our services for another funeral service provider.BASIC SERVICES OF FUNERAL DIRECTOR, STAFF & OVERHEAD FOR TRANSFER TOANOTHER FUNERAL HOME, REMOVAL AND EMBALMING SERVICESConsultation with a Texas or Louisiana Licensed Funeral Director at Our Funeral Home, Medical Facility or ByTelephone, these contractual fees will be billed to receiving funeral home when family terminates our servicesfor another funeral home service provider. All fees are due when receiving funeral home arrives to retrieve yourlove one from our professional care to their funeral home. Only a licensed funeral director can make the removalfrom out funeral home protecting the best interest of all parties.Basic Services (Consultation Fee) 500 Removal 495 Embalming 1500 2,495.00ANATOMICAL EMBALMING SERVICES 1,500.00 **Coronavirus Contract Specialist Embalming Services, 2,500.00Embalming is not required by law. Embalming may be necessary, however, if you select certainfuneral arrangements, such as a funeral with viewing. If you do not want embalming, you usually havethe right to choose an arrangement that does not require you to pay for it, such as direct cremation orimmediate burial. Children Embalming Services Ages 0-2 500.00Ages 3-17 1000.00Special Handling, Additional Uniforms, Safety Equipment & StorageOTHER CARE AND PREPARATION OF THE BODYBathing BodyCosmetic/Beautician (Basic Wash, Comb and Style)Dressing/Casketing Refrigeration per day after Removal/Cremation Permits Issued/Plus Any DelaysHair Stylist for Specialty Style including Braids and Dying of Hair 50.00 ** 100.00 ** 170.00 ** 100.00 150.007 Page10/1/2020
AT-NEED SPECIAL CARE SERVICESSpecial Care for Autopsied Cases or Body Donation RepairsFull Autopsy including Temporal Bone A Repairs 395.00 495.00SUPERVISION OF SERVICES AND USE OF FACILITIESIdentification Viewing up to 10 People for One Hour in Stateroom 395.00Viewing/Visitation/Wake/Rosary/Prayer Services 795.00Funeral Ceremony at Funeral Home with One Hour ViewingFuneral Ceremony at Funeral Home with Two Hours Viewing 795.00 ** 995.00Funeral Ceremony at Other Facility with One Hour ViewingFuneral Ceremony at Other Facility with a Two Hours Viewing 795.00 995.00Memorial Service at Funeral Home 795.00Memorial Service at Other Facility 795.00Use of Equipment and Staff for Graveside Service 795.00Extended Service Time per Hour 300.00OTHER FACILITIES OPTIONSUse of Facilities for Reception (2 Hours) Includes 7 Tables/70 Chairs/Cleaning Fee 350.00TRANSPORTATION SERVICESTransfer of Remains to Funeral Home 495.00 **(Within 50 Miles Radius of any of Our Funeral Homes)The charge for additional mileage is 3.00 per mile (one way)Hearse (Funeral Coach) per Trip 495.00 **(Within 50 miles Radius)The charge for additional mileage is 3.00 per mile (one way)Limousine within a 50-mile radius for 5 hours:Home to Funeral Home/Church to Repast to Home (5) HoursFuneral Home/Church to Cemetery and Return 495.00 ** 295.00Additional Pickup Location 50.00 per Location 125.00 per hour after time frame and will be added to your final funeral billClergy Sedan Transportation of Minister to Church/Cemetery/ChurchFlower Van Transportation from Funeral Home to Church to CemeteryOther: Service Vehicle (Death Certificates, Permits & Documentations)Transfer to and from Crematorium or Autopsy FacilityAirport Transfer (Shipping or Receiving)Motorcycle Hearse 1500.00Horses & Open Wagon 1500.00Horses & Closed Carriage** Traditional Funeral with Same Day Services 200.00 200.00 200.00 ** 495.00 495.00 2500.00Total Professional Service Fees without Limousine 6,700.00Total Professional Service Fees with Limousine 7,195.00 **8 Page10/1/2020
OTHER SERVICES:FORWARDING OF REMAINS TO ANOTHER FUNERAL HOME 4,910.00Services include: Basic Services of staff, Removal of remains, Embalming, necessary authorizations, Dressing andPlacement in Casket/Container and Other preparation includes air tray /combo unit and service vehicle. Not included arecasket or air tray/combo purchase, use of facilities & staff for visitation/ceremonies, shipping charges and additionaltransportation.RECEIVING REMAINS FROM ANOTHER FUNERAL HOME 2,890.00Services include: Basic services of staff, transportation of remains to cemetery or crematory within 50-mile radius.(This excludes private and common carrier (airlines), casket/container, dressing and casketing, viewing, visitation, rites orceremonies.)IMMEDIATE BURIALOur charge for immediate burial includes: basic service of funeral director and staff; removal of remains; dressing,casketing and other care; and local transportation of the deceased to the cemetery. Immediate burials are withoutservices, rites and ceremonies at the funeral home, graveside or elsewhere and will be conducted at theconvenience of the funeral home and cemetery. Immediate Burial with container provided by purchaser Immediate Burial with minimum casket selected from our funeral homeDIRECT CREMATION (Basic Charge) Non-Ceremonial Services*Expedited Cremation 3-7 Days This is a rush cremation service.*Direct cremation with container provided by purchaser (None-Expedited to 225 Pounds)*Direct cremation with alternative container selected from our funeral homeDirect, Traditional or Memorial Cremation services weight fee applies;(100 - 225 Body Weight)Included(225 - 275 Body Weight)Add(275 - 325 Body Weight)Add(325 - 500 Body Weight)AddAdditional Charges: Coronavirus Contract Specialist Services, Special Handling,Additional Uniforms, Safety Equipment & Storage 3,705.00 4,500.00 3,390.00 1,695.00 1,695.00 (PreNeed) 325.00200.00400.00600.00 495.00Our charge for direct cremation (without services) includes: Professional Service Fee; removal of the remains (within a 50miles radius); basic sanitary care, transportation to crematory; completion of necessary authorizations; filing deathcertificate; and use of facility for the shelter of body. This charge DOES NOT include the use of the facilities and staff forany visitation or ceremony, public or private, at the funeral home, graveside and elsewhere. If you want to arrange a directcremation, you can use an alternative container. Alternative containers encase the body made of material like fiberboard(with outside covering).Miscarriage less than 7 Months7 Months to 18 Months Direct Cremation19 Months to Age 5 395.00 495.00 595.00In addition, and only when it requires receiving a cremation permit: 120.00Cremation Authorization from Medical Examiner from 100.00( 99.00 Trip Charge, Parking, Tolls, and 21.00 Permit Fee)Packaging, Mailing & 2,500 Liability Insurance (Cremated Remains & Death Certificates) 695.00Delivery of Cremains and Death Certificates to your Home or Office 65.00Witness of Cremation with Licensed Funeral Director Fee (Scheduled within 5 Days) 1,495.00Private Identification Viewing at Funeral Home (One Hour in a Stateroom) 2
processed by Lincoln Financial Factoring, LLC), (10) Advance payment by a forwarding funeral home, 11) Advance payment by a receiving funeral home, and (12) Preneed funeral fund from another funeral home. ALL SERVICES ARE PENDING UNTIL PAID OR APPROVED FOR PAYMENT. Payment for Services and Merchandise is expected prior to the services rendered.
