Authorization for the Burial at Sea of Cremated Remains

Date of authorization _____________________________

I/We the undersigned hereby request and authorize  SEA SERVICES Inc.  (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

I/We hereby direct Sea 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 Sea Services via __ * U.S. Registered Mail - __ Other (note)_______________________
*Neither the Company nor Sea 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 the Company, or its agent Sea 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, Sea Services reserves the right, at its sole discretion, to dispose of the container which contained said cremated remains.
The obligation of the Company and Sea 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.

MAKE 3 COPIES
ORIGINAL TO SEA SERVICES ~ COPY TO FUNERAL DIRECTOR ~ COPY TO CLIENT

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