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Authorization

for the

Scattering of Cremated Remains at Sea

by

Blue Pacific Ashes at Sea

I/we hereby authorize Blue Pacific Ashes at Sea to take possession of and make arrangements of the disposition of the cremated remains of the following named deceased:  _______________________________________________________,

in accordance with all applicable rules, regulations for all federal, state and local laws.

I/we certify, warrant and represent that I/we have the full legal right and authority to authorize the disposition of the cremated remains of the deceased.

I/we hereby authorize Blue Pacific Ashes at Sea to dispose of  cremated remains of the deceased in the Pacific Ocean, coastal oceans waters of  Palos Verdes, San Pedro, Ca. USA.

Blue Pacific Ashes at Sea will dispose of the cremated remains in a timely manner,  unless specific there are Blue Pacific is directed otherwise:_____________________________

_______________________________________________________________________

Cremated remains will be taken by Blue Pacific Ashes at Sea’s own vessel and scattered at sea.  Once the cremated remains are scattered, they are unrecoverable.  Unless directed to the contrary, Blue Pacific Ashes at Sea reserves the right to dispose of the container that held the remains.  The obligation of Blue Pacific Ashes at Sea will be limited to the disposition of the cremated remains as directed herein.  I/we agree to release and hold harmless Blue Pacific Ashes at Sea, its affiliates, 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.

____________________________________            ______________________________

Signature                                  Date                             Relationship to Deceased

____________________________________

Print Name

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Address                                   City                              State                            Zip

________________________________________________________________________

Phone                                                               E-mail

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