Pre-Paid Funeral/Cremation Verification

Please specify the amount for each category:

1. Burial plot, gravesite, crypt, mausoleum, or niche

2. Casket or urn

3. Other repository customarily and traditionally used for the deceased’s bodily remains

4. Vaults or other burial containers

5. Headstones, markers or plaques

6. Arrangements for the opening and closing of the gravesite

7. Contract for the care and maintenance of gravesite (endowment)


8. Transportation of body

9. Embalming

10. Cremation

11. Flowers

12. Clothing

13. Services of funeral director and staff


All Contracts Must Be Irrevocable

Is the headstone required to be purchased at the same time as the burial plot3?

If purchased, will the headstone be carved (except for date) and be installed at the gravesite3?

If the value of items 8 through 13 are above the program limits, the contract must be purchased in the name of CPT AS TRUTEE FBO (CLIENT’S FULL NAME)

1Items 1 through 7 are excluded no matter the value
2Max value for items 8 through 13:

  • SSI Recipients - $1,500
  • Medicaid only - $1,800
3For Medicaid only recipients, the headstone is excluded if:
  • It is required to be purchased at the time of the burial plot or,
  • If it is not required to be purchased, the headstone must be carved (except for the date) and installed at the gravesite