(a) Every person licensed pursuant to article 34 of the Public Health Law, including funeral directors and funeral firms, shall furnish at the time funeral arrangements are made for the cremation of the body of a deceased person, to the person or persons making arrangements, a written statement which shall include the following:

1. (1) true firm name and address as registered with the department;
2. (2) the signature and printed or typed name of the funeral director or undertaker making funeral arrangements, and the date such statement was furnished to the customer;
3. (3) name of deceased, together with the place and scheduled date of cremation;
4. (4) a statement, by the person making the arrangements, indicating the manner of disposition of the cremains;
5. (5) the dated signature, address and phone number of the person making the arrangements; and
6. (6) a disclosure statement by the funeral director or undertaker making the arrangements, indicating the manner of disposition of the cremains if unclaimed after 120 days from the date of cremation.

(b) The funeral firm's copy of the customer's designation of intentions shall include he following:

1. (1) the actual date of cremation, and the name and location of crematory;
2. (2) the date, location and manner of disposition of cremains; and
3. (3) the dated signature and printed or typed name of person making disposition of cremains.