Scattering Authorization Form
print this page and fill out the necessary information, and mail
authorize "Ashes in Paradise" to provide the ash
scattering service of the following deceased person:
Legal Name of Deceased:
Date of Birth _______________ Date of
Death ________________ M/F ________
Name of Crematory & Permit #
I request the ash
scattering to be performed within 30 days of receipt of these
remains, weather permitting, off the shores of the Big Island of
Hawaii. I fully understand that the cremated remains are not
recoverable once the scattering service has been performed.
"Ashes in Paradise" to dispose of the container labeled
"cremated remains" at their sole discretion, unless
specifically requested otherwise in a separate letter attached to
this authorization form.
I will hold
harmless "Ashes in Paradise" and its employees of authorized
representatives from any and all loss, damage liability, or causes
of action ( including all attorney and litigation expenses) in
connection with the disposition of the cremated remains of the
above named deceased. "Ashes in Paradise" is not
responsible for any loss or damage caused by any third
party. Any liability of "Ashes in Paradise" shall
be limited to the costs of the scattering service provided.
I hereby certify
that I have full legal control of the disposition decisions of the
above named deceased.
Relationship to Deceased
Legal Name of
Social Security # of Deceased
Funeral Director & Permit Number ...or... Crematory &
If you have any
questions, please don't hesitate to contact
us via email or call us at 808-987-0920 (USA) / 808-987-0920
(international / local).