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Authorization for the Burial at Sea. of (Family members) Bodily Remains
Date of Authorization; this ______________Day of _________________________ 20______.
I/We the undersigned hereby request and authorize FUNERAL-AT-SEA (hereafter referred to as the
“Company”) to take possession of and make arrangements for, the transportation and disposition of the
Bodily 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; (c) any applicable Federal, State,
Provincial or Local Laws and Regulations; and (d) Maritime law. I/We certify, warrant and represent that
I/We have the full legal right and authority to authorize the disposition of the bodily remains of the Deceased.
I/We certify, and hereby authorize the Company to make disposition of bodily remains of the Deceased at sea in:
____ Gulf of Mexico, ____ Pacific Ocean, ____ Atlantic Ocean, ____ Caribbean Sea,
____ Bering Sea,
____ The Great Lakes, or (Other)
_____________________________________________________________.
I/We do hereby instruct and direct Company to disseminate the Cremated bodily remains at sea,
or to Intern the body in a full body burial at sea in accordance with A, B, C, & D.
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Burial to be WITNESSED by Family _____Yes _____ No.: (Name) ___________________________________
Burial to be accompanied by CLERGY _____Yes _____No.: (Name) _________________________________
Burial to be PERFORMED by Family Member _____Yes ______No.: (Name) __________________________
Burial at Sea is to be from a Maritime vessel.
_____ Burial at Sea is to be at the bottom of the Sea (By __Diver, __Submersible,
__Robot, ___Natural placement).
_____ Burial at Sea is to be from aircraft.
Shipping/Transporting of the Deceased along with all the required documents and disclosures to
FUNERAL-AT-SEA by _____________________________________________ Funeral Establishment,
via ____*U.S. Registered Mail, ____ Air/Rail - ___ other __________________________________________
(note) Neither the Company nor its Agent, are responsible for any loss or damage of/to the
Casket, Body, Cremated
bodily remains of the Deceased, or the Ocean Urn, its outer container or the shipping container they are
shipped in. Shipping is to be by; U.S. Registered Mail, Commercial Carrier, Airline Carrier or U.S. Rail
system. If no specific instructions are provided herein (see BACK of this document), Burial at Sea will be
performed by the Company, or its agent:___________________________________, at the discretion and
convenience of the Company. Dissemination consists of the scattering or placement of the Cremated
bodily remains at sea in a manner so that tide and current will scatter the cremated remains, or through
the placement on the sea floor of a burial urn containing the cremated
remains, The body with all required
antibuoyancy equipment, casket. I/We understand that once the remains of the Deceases are disseminated,
they are unrecoverable. Unless otherwise specifically provided for herein, once dissemination of Cremated bodily
remains of the Deceased has been performed, FUNERAL-AT-SEA reserves the right, at its sole discretion,
to dispose of any remaining container which may have contained said bodily remains. The obligation of
the Company and its Agent shall be limited to the disposition of the Bodily 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 cause of action (including attorney’s fee and
expenses of litigation) in connection with the disposition of the bodily remains of the Deceases as authorized
herein or in respect to the Identification of said bodily remains as being those of the Deceased.
Signature: __________________________________________
Print Name: __________________________________________
Relationship to Deceased: __________________________________________
Address ________________________________________________________
City/State ________________________________________________________
Telephone Number ________________________________________________
witnessed:________________________________________________________ Date: ____________________
Notary Seal and Stamp.
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