Unattended scattering at sea Authorization form

San Francisco Bay Boat Memorials Authorization for the Scattering of Cremated Human Remains at Sea

  

I hereby authorize SF BAY BOAT MEMORIALS (Captain Dave Gallegioni, CRD Lic. #901 or his designee) to take possession of and make arrangements for, the disposition of the cremated remains of  _________________________________ __________ _____("Deceased") in accordance with and subject to the terms and conditions set forth in this Authorization; the Company's Rules and Regulations; and any applicable federal, state, provincial or local laws and regulations.

I certify that I have the full legal right and authority to authorize the disposition of the remains of the Deceased.

I hereby authorize SF Bay Boat Memorials (Captain Dave Gallegioni) to make disposition of cremated remains of the Deceased at sea in: _ __ Pacific Ocean  or ___San Francisco Bay  (please check one).

I hereby direct SF Bay Boat Memorials  (Captain Dave Gallegioni) to scatter said cremated remains at sea, in accordance with California State and Federal Law.

Special Instructions :
 

____________________________________________________________________________

____________________________________________________________________________
 

If no specific instructions are provided herein, scattering will be performed by SF Bay Boat Memorials in a timely manner, weather and circumstances permitting.

"Scattering" consists of the scattering of cremated remains at sea including the San Francisco Bay generally in the vicinity of the Golden Gate Bridge. I understand that once the cremated remains of the Deceased are scattered, they are unrecoverable. Unless otherwise specifically provided for herein, once scattering of cremated remains of the Deceased has been performed, SF Bay Boat Memorials (Captain Dave Gallegioni) will dispose of the container which contained said cremated remains.

The obligation of SF BAY BOAT MEMORIALS shall be limited to the disposition of the cremated remains as directed herein. I agree to release and hold harmless SF Bay Boat Memorials (Captain Dave Gallegioni), its' designee, 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.


  

___________________________

Signature


__ _________________________ 

Print Name


___ ________________________
 Relationship to Deceased

  

 ___________________________,
Address


 ____________________, ____ ____________
City     State     Zip Code


__________________
Date 



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