Los Angeles Yacht Charter Ashes at Sea

Authorization

for the

Scattering of Cremated Remains at Sea

Los Angeles Yacht Charter Ashes at Sea

I/we hereby authorize Los Angeles Yacht Charter 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 Los Angeles Yacht Charter 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.

Los Angeles Yacht Charter Ashes at Sea will dispose of the cremated remains in a timely manner, unless specific there are Los Angeles Yacht Charter is directed otherwise:______

______

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

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SignatureDateRelationship to Deceased

______

Print Name

______

AddressCityStateZip

______

PhoneE-mail

Please attach a check and return this document to

Los Angeles Yacht Charter

2785 Pacific Coast Highway Suite 209

TorranceCalifornia90505

You can also hand deliver a box with this agreement and the contents to the address above. Please give us 24 hours notice of a hand delivery.

Credit Card Authorization:

Name of the Card______

Billing address of the Card______

Card number ______

Expiration date on the Card______

Security Number on the Card______

Dollar amount authorized for this charge $______

Original Copy to Los Angeles Yacht Charter Ashes at Sea (Keep a Copy)