Unattended Scattering Ashes Authorization Form
If you are considering utilizing our service for an offshore scattering, kindly click on the following link to access the Unattended Authorization form. Please download two copies: one for our records and one for yours. This will enable us to proceed with filing the necessary paperwork and selection of the next available date.
Should you have and questions or concerns, don’t hesitate to contact us.
Thank you,
Capt. Ron
Long Island Boat Charters Inc
Authorization for Scattering Cremated Remains at Sea
34 Sunset Lane
Patchogue NY 11772
516-523-0155
www.LongIslandBoatCharters.com
Unattended Disposition of Remains Authorization
I, _________________________________________, authorize Long Island Boat Charters Inc to take possession and make arrangements for the disposition of the cremated remains of __________________________________________, referred to as the “Deceased” at sea in accordance with and subject to the terms and conditions set forth in this authorization and the rules and regulations and policies of this company and in accordance of all applicable State, Federal , Environmental and local laws rules and regulations.
I certify and represent that the cremated Remains being released to the Company are those of the deceased listed above and that I have the legal right and authority to designate Long Island Sea Burials the irretrievable scattering of said remains.
If there are no specific instructions outlined below, the scattering of said cremated remains will be done in a timely manner between April and November subject to weather conditions.
Unless otherwise specifically provided herein, once dissemination of cremated remains of the deceased has been performed, company has the right at its sole discretion to dispose of the container as we deem environmentally legal and appropriate unless otherwise outlined below.
The obligation of 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 fees and expenses of litigation) in connection with the disposition of said remains.
Special Instructions: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Date______________________________________
Signature__________________________________Print Name ______________________________________
Address_________________________________City, State , Zip Code_______________________________
Relationship to Deceased___________________________________________________________________
Telephone number_________________________
Witness___________________________________Print Name______________________________________
Date_____________________________________
Address_________________________________City, State, Zip Code________________________________
Relationship to deceased____________________________________________________________________
Telephone number_________________________
DOS Signature_____________________________Print Name_______________________________________
Date_____________________________________
