Form DD Form 3004 DD Form 3004 Statement of Disposition of Civilian Remains

STATEMENT OF DISPOSITION OF CIVILIAN REMAINS

OMB No. 0704-AABF
OMB approval expires

(Read Agency Disclosure Notice, Privacy Advisory, and Instructions on Page 2 before completing this form.)
1. NAME OF DECEASED (Last, First, Middle Initial)

2. AGENCY/ORGANIZATION

3. DCIPS CASE NUMBER

4. PERSON AUTHORIZED TO EFFECT DISPOSITION (PAED)
a. NAME (Last, First, Middle Initial)

b. RELATIONSHIP TO DECEASED

c. TELEPHONE NUMBER (Include
Area Code)

d. CURRENT RESIDENCE ADDRESS (Street, Apartment Number, City, State and ZIP Code)

5. SELECTION OF DISPOSITION OPTIONS
I, the undersigned PAED, have been provided a mortuary briefing and I understand each of the options presented and have selected disposition of
remains as indicated below. I understand that the embalming/preparation, restoration, and casketing of remains, if requested under Options 1 - 3, may be
provided by a civilian funeral home, under contract with the DoD, or a Mortuary operated by the Department of the Army, Navy, or Air Force.
OPTION 1
I authorize the Military to assume custody of remains for embalming/preparation, restoration, dressing or wrapping, with placement in the
military specification casket selected in Block 8, and request transportation to be arranged, and if authorized, with escort, at government
expense to the funeral home listed in Block 6, with subsequent interment/entombment in the cemetery listed in Block 7.
(Initials)

OPTION 2

(Initials)

I authorize the Military to assume custody of remains for embalming/preparation, restoration, dressing or wrapping. I desire to select a casket,
of my choosing, and acknowledge the cost may be at my expense, from the funeral home designated in Block 6. I authorize the Service to
effect transportation of remains in funeral industry standard combination shipping container and if authorized with escort, at government
expense to the funeral home listed in Block 6, with subsequent interment/entombment in the cemetery listed in Block 7.

OPTION 3
I authorize the Military to assume custody of remains for embalming/preparation, restoration, dressing or wrapping, with placement in a wood
cremation casket, with cremation to be arranged by the PAED with the receiving funeral home, listed in Block 6, in accordance with all
applicable statutory provisions. The Military will provide the urn selected in Block 9, unless declined by initialing the applicable box in Block 9,
and arrange transportation of the casket and, if authorized, an escort at Government expense.
(Initials)

OPTION 4

NEEDS DD67

I desire to MAKE ALL ARRANGEMENTS for the disposition of remains. If the remains are under the control of the DoD, I direct the remains
be released to the funeral home listed in Block 6. Coordination must be made with the Casualty/Mortuary Affairs Officer to identify possible
defrayment of costs incurred if any defrayment is available in having elected to make my own disposition arrangements.
(Initials)

OPTION 5

I HEREBY RELINQUISH MY RIGHTS to all decisions regarding the disposition of the remains and understand that the right to effect
disposition of the remains will pass to the next person in hierarchy by marriage, blood relation, or adoption and whose name is listed below. I
also certify that I have the legal right to make this authorization and release the DoD, its officers, agents, and employees from any and all
liability that may arise from this action. By law, the PAED to whom the authority to effect disposition passes is (Name/relationship):

(Initials)

6. RECEIVING FUNERAL HOME (Name, Address (include ZIP Code) and
Telephone Number (Include Area Code)

8. CASKET SELECTION (Applicable to Options 1-3)

7. CEMETERY (or where final disposition of remains is to be effected)
(Name, Address (include ZIP Code) and Telephone Number (Include Area Code)

9. URN SELECTION (Applicable to Option 3)

18-GA Steel with Silver Tone Finish

Solid Bronze

Solid Hardwood with Walnut Finish

Solid Walnut

I decline a casket provided by the Military
10.a. TYPED OR PRINTED NAME OF PAED
AUTHORIZED TO EFFECT DISPOSITION

I decline an urn provided by the Military
b. SIGNATURE OF PAED AUTHORIZED TO EFFECT DISPOSITION

c. DATE (YYYYMMDD)

11.a. TYPED OR PRINTED NAME OF WITNESS

b. SIGNATURE OF WITNESS

c. DATE (YYYYMMDD)

DD FORM 3004, 20250407 DRAFT

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STATEMENT OF DISPOSITION OF CIVILIAN REMAINS
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to
the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-informationcollections@mail.mil. Respondents
should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of
information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION.
PRIVACY ADVISORY
Disclosure of this information is voluntary and will be used to document your decisions about the remains of the decedent. When completed, this form
contains personally identifiable information and is protected by the Privacy Act of 1974, as amended.

INSTRUCTIONS

The Statement of Disposition of Remains form is a written
declaration from the Person Authorized to Effect Disposition
(PAED) authorized to effect disposition as to their intent,
wishes, and directions for the Service to ensure the
expeditious embalming/preparation, and transportation to the
place directed by the PAED.
This form is to be presented to the PAED when discussing
mortuary entitlements by the Casualty Assistance Officer,
Casualty Assistance calls Officer or Mortuary Officer during
the mortuary briefing.

During the embalming/preparation process, the embalmer
may utilize some or all of the following techniques: physical
disinfection of the remains; arterial and surface embalming;
treatment and closure of wounds/incisions; dressing and
wrapping of wounds; dermasurgery or physical restorative
measures such as artificial reproduction of facial features in
an attempt to recreate natural form and color, and applying
cosmetics.

NEEDS DD67

The PAED must elect an option from Options 1 - 3 by
initialing the space under the option number and provide
information required in Blocks 6 - 10.

There are three purposes of embalming; an explanation of
each is listed below. Combined, the intent is to facilitate a
family's ability to view their loved one, should the
circumstances of death allow.
(1) Disinfection - destruction or inhibition of pathogenic
organisms and their products in or on the body.
(2) Preservation - the science or treatment of the body
chemically to temporarily inhibit decomposition during the
interval between death and final disposition by burial,
cremation, entombment or other means.
(3) Restoration - the care given the deceased to recreate
natural form and color.

DD FORM 3004 INSTRUCTIONS, 202501407 DRAFT

Depending on circumstances, restoring the remains to an
acceptable physical appearance may not be possible. The
PAED will be advised when the deceased cannot be restored
to a viewable condition. There are two classifications of
restorative art: minor and major.
Minor restorations include, but are not limited to, correction a
misaligned fracture, hypodermic tissue building, reduction of
swelling, sub-tissue surgery (mouth or eye), waxing (lips,
abrasions, sutures or razor burns), suturing clean cuts, small
hair replacements (eyebrow, eyelash, or temporal hair),
bleaching and concealing minor discolorations or removal and
restoration of fever sores (scabs). Consent from the PAED is
granted by signing Block 10.b of this form.

STATEMENT OF DISPOSITION OF CIVILIAN REMAINS
INSTRUCTIONS (Continued)
Major restorations include, but are not limited to, the
restoration of a full head of hair, sub-tissue surgery of a
swollen neck, problems with buck-teeth, deep wound
preparation (after excision of necrotic, mutilated or diseased
tissue), care of deep lacerations, repair (or reconstruction) of
multiple fractures, third-degree burns, skin slip,
dismemberment of a limb (or head), and complete loss of a
part. Technical skill is required to artificially construct a
distorted portion of the face or cranium, wax surfacing over a
large wound (cheek, forehead, or neck), modeling a facial
feature, achieving a natural appearance when masking a
completely discolored face (or large post-mortem stain) with
opaque cosmetics or matching wax with the complexion.
Consent from the PAED is granted by signing Block 10.b of
this form.
By selecting Options 1 - 3 and signing Block 10.b, the PAED
hereby authorizes the Department of Defense, and its
personnel to undertake, or direct a funeral home under
contract with the Military to undertake the remains preparation
process and restorative procedures, deemed necessary in the
embalmer's professional practice, to provide the greatest
opportunity for a viewing, should the family elect to view the
deceased.

When the PAED requests to make all the arrangements for
disposition, outside the Military, or when he/she requests
services or merchandise beyond that which the Military can
provide within DoD standards, Option 4 must be selected.
Option 4 must also be selected if the deceased has already
been moved to the PAED's selected funeral home and
embalmed/prepared, and the PAED does not wish the Military
to engage on his/her behalf, for re-processing of the remains
through the installation contract mortuary. The Mortuary
Officer should never require and express there is a
requirement for remains inspection under Option 4.
When the PAED does not wish to fulfill the designated
responsibilities of a PAED and therefore requests to relinquish
the right to make any decisions regarding the disposition of
the remains of the deceased whose information is listed in
Blocks 1 - 3, the PAED must select Option 5. The disposition
authority will pass to the next person in hierarchy by
marriage, blood relation or adoption (i.e., spouse, child,
parent, brother or sister, etc.) according to Law.
The person recognized to fulfill the PAED responsibilities will
complete a new Statement of Disposition of Civilian Remains.
Both forms must be included in the Individual Deceased
Personnel File.

NEEDS DD67

In all cases where the PAED elects Option 1 - 3, the Military
will utilize the standards of the Standards for DoD Mortuary
Facilities And For Drafting A Performance Work Statement
(PWS) For DoD Contracted Mortuary Services as the
minimum standards in the embalming/preparation/restoration
of the deceased remains. If the PAED expresses a desire to
not have the deceased embalmed/prepared, the Military will
honor this request and advise the PAED of the support
available for funeral services held under Option 4.

When the PAED selects Option 3 (Cremation): The
Department of Defense will honor a PAED's request for
cremation by preparing or directing the contract funeral home
to prepare the remains in accordance with DoD standards.
The deceased will be placed in a specification wood casket.
Additionally, the Department of Defense will provide a Military
Specification Urn as selected in Block 9. The Department of
Defense will reimburse the cost of the cremation.

DD FORM 3004 INSTRUCTIONS (BACK), 20250407 DRAFT