(a) Upon receipt of the human remains, the crematory authority shall furnish to the person who delivers such human remains, a receipt signed by both the crematory authority and the person who delivers the human remains, including the following information:

1. (1) The date of delivery;
2. (2) The name of the person from whom the human remains were received, and that person’s employer;
3. (3) The name of the person who received the human remains on behalf of the crematory authority;
4. (4) The name and license number of the crematory authority; and
5. (5) The name of the deceased.