Date of thisAuthorization _________________________ Control # _______________________________
1. I/We the undersigned hereby request and authorize ASHES UPON THE SEA, INC., hereafter referred to as the "Company," to take possession of and make arrangements for, the disposition at sea of the cremated remains of ______________________________, hereafter referred to as the "Deceased," in accordance with and subject to: a) the terms and conditions set forth in this Authorization; b) the Company's Rules and Regulations; and c) any applicable federal, state, or local laws and regulations.
2. I/We certify, warrant and represent that I/We have the full legal right and authority to authorize the disposition of the remains of the Deceased.
3. I/We hereby authorize the Company to make disposition of cremated remains of the Deceased at sea in the Atlantic Ocean off the coast of the State of Florida, USA
4. I/We hereby direct the Company to transport for the purpose of burial at sea said cremated remains upon a lawfully United States registered vessel, and to bury said cremated remains in accordance with State and Federal Law.
5. If no specific instructions are provided herein, burial at sea will be performed by the Company at the sole discretion and convenience of the Company within sixty (60) calendar days from the date of receipt of the cremated remains depending upon weather, sea conditions and vessel availability. Most scatterings are performed within ten (10) days of receipt of the cremated remains.
6. Dissemination consists of the scattering of cremated remains at sea. I/We understand that once the cremated remains of the Deceased are disseminated, they are unrecoverable.
7. Unless otherwise specifically provided for herein, once dissemination of cremated remains of the Deceased has been performed, the Company reserves the right, at its sole discretion, to dispose of the container, which contained said cremated remains.
8. The obligation of the Company shall be limited to the disposition of the cremated remains as directed herein. I/We agree to release and hold harmless the Company, its affiliates and their agents, employees, successors and assigns from any and all loss or damage of cremated remains shipped via Registered Mail with the United States Postal Service or any other means of shipment.
9. I/We agree to release and hold harmless the Company, its affiliates and their agents, employees, successors and assigns from any and all loss, damage, liability or causes of action (including attorney's fee and expenses of litigation) in connection with the disposition of the cremated remains of the Deceased as authorized herein or respect to the identification of said cremated remains as being those of the Deceased.
10. I/We understand and agree that all fees for services and costs for burial merchandise as ordered and requested must be paid in full before the Company is obligated to dispose of the cremated remains as directed herein.
Poem, Prose, Prayer, Scripture, Other:
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Signature
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