Authorization for the Burial at Sea of Cremated Remains
Date of authorization _____________________________
I/We the undersigned hereby request and authorize BEYOND THE SEA MEMORIAL SERVICES. (hereby referred to as the "Company") to take possession of and make arrangements for, the disposition 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, provincial or local laws and regulations.
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.
I/We hereby authorize the Company to make disposition of cremated remains of the Deceased at sea in San Pedro (Los Angeles), California
I/We hereby direct BEYOND THE SEA MEMORIAL SERVICES to disseminate said cremated remains at sea, in accordance with State and Federal Law.
Special Instructions
_______________________________________________________________________________________________________
Dissemination to be Witnessed by Family __ Yes __ No
Dissemination to be Performed by Family __ Yes __ No
Shipped to BEYOND THE SEA MEMORIAL SERVICES via __ * U.S. Registered Mail - __ Other
(note)_______________________
*Neither the Company nor BEYOND THE SEA MEMORIAL SERVICES is responsible for any loss or damage of
cremated remains shipped via Registered Mail with the United States Postal Service
If no specific instructions are provided herein, Burial at Sea will be performed by
BEYOND THE SEA MEMORIAL SERVICES, at the discretion and convenience of the Company.
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.
Unless otherwise specifically provided for herein, once dissemination of cremated remains
of the Deceased has been performed, BEYOND THE SEA MEMORIAL SERVICES reserves the right, at its sole
discretion, to dispose of the container which contained said cremated remains
unless specific arrangements have been made prior to the dissemination of the
remains.
The obligation of BEYOND THE SEA MEMORIAL SERVICES shall be limited to the disposition of the
cremated remains as directed herein. I/We agree to release and hold the Company, Its
affiliates and their agents, employees, successors and assigns harmless 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.
| _________________________________________ | _________________________________________ | _______________________________ |
| Signature | Print Name | Relationship to Deceased |
| _________________________________________ | _________________________________________ | _______________________________ |
| Address | Telephone Number | |
| _________________________________________ | _________________________________________ | _______________________________ |
| Signature | Print Name | Relationship to Deceased |
| _________________________________________ | _________________________________________ | _______________________________ |
| Address | Telephone Number | |
| _________________________________________ | _________________________________________ | _______________________________ |
| Signature | Print Name | Relationship to Deceased |
| _________________________________________ | _________________________________________ | _______________________________ |
| Address | Telephone Number |
MAKE 3 COPIES
ORIGINAL TO BEYOND THE SEA MEMORIAL
SERVICES ~ COPY TO FUNERAL
DIRECTOR ~ COPY TO CLIENT
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