1. I/We hereby authorize Mountains to Sea Burials, hereinafter known as the “Company,” to take
possession of and disseminate the cremated
(hereinafter known as the “Deceased”) in accordance with:
a) the terms and conditions set forth in this authorization form,
b) all regulatory guidelines, and
c) the rules of the Company.
2. I/We hereby certify that I/We have the full legal right to authorize the disposition of the remains of the
Deceased.
3. I/We hereby authorize the Company to perform a burial at sea by scattering the cremated remains of
the Deceased. I/We understand that once the ashes are scattered, they are unrecoverable.
4. If no specific instructions are provided herein, the Company will perform the burial at sea within thirty
(30) days from receipt of the cremated remains, depending on weather, sea conditions, and vessel
availability.
5. I/We hereby agree to release and hold harmless the Company, its employees, affiliates, agents,
successors, and assigns from any loss or damage of the cremated remains shipped via Registered Mail
or any carrier used for transport.
6. I/We hereby agree to release and hold harmless the Company, its employees, affiliates, agents,
successors, and assigns from any and all loss, damage, or liability (including attorney fees and litigation
expenses) in connection with the final disposition of the cremated remains of the Deceased as
authorized herein, or with respect to the identification of the Deceased’s remains.
7. I/We hereby agree that all fees and costs associated with the burial at sea ordered and authorized by
me/us must be paid in full before the Company will perform the burial at sea.
Authorizing Party #1
Authorizing Party #2
