Date of Authorization_____________________.

I/We the authorized hereby request and authorize Coastal Sunset Memorial to take possession of and make arrangements for the disposition of the cremated remains at sea of _____________________________________________ (deceased). In accordance with all applicable rules and 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 remains of the deceased.

I/We hereby authorize Coastal Sunset Memorial to make disposition of cremated remains of the deceased at sea in _______ Pacific Ocean _______ Other,
Please specify: _______________________________________________________________.

Dissemination to be witnessed by Family/Friends _____Yes _____No
Dissemination to be performed by the Family _____Yes _____No

Shipped to Coastal Sunset Memorial via _____ US Registered Mail _____ Other
(Note): __________________________________________________________________________________________________ .

*Coastal Sunset Memorial is not responsible for any loss or damage of cremated remains shipped via Registered Mail with the United States Postal Service or any other shipping means. Special Instructions:
__________________________________________________________________________________________________________ _________________________________________________________________________________________________________.

Unless specific instructions are provided herein, dissemination will be performed by the discretion of Coastal Sunset Memorial. Unless a date is requested, the scattering and notification to family will occur within 30 days of receipt of the ashes. You will be notified by e-mail or phone. 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, Coastal Sunset Memorial reserves the right, at its sole discretion, to dispose of the container which contained said cremated remains. The obligation of Coastal Sunset Memorial will be limited to the disposition of the cremated remains as directed herein. I/We agree to release and hold Coastal Sunset Memorial and it's employees harmless from any and all loss, damage, liability or causes of action (including attorney's fee and litigation expense) 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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Signature	Print Name	Relationship to Deceased
______________________________________________________________________________________
Address	City	State	Zip
______________________________________________________________________________________
Phone #	E-mail