ALOHA BOAT CHARTERS

            Date of  Authorization _________________________

             I/We the undersigned hereby request and authorize ALOHA BOAT CHARTERS (hereby referred to as the “Company”) to take possession of and make arrangements for the disposition of the cremated remains of___________________________________________________      (hereby referred to as the “Deceased”) in accordance with and subject to: a) the terms and conditions in this Authorization; b) any applicable federal, state, or local laws and regulations.

             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. at sea in the Pacific Ocean, Oceanside, California

            Special Instructions:        ________________________________________________________________________________________________________________________________________________________________                        Cremated remains shall be delivered to the Company By the following means:

              Shipped to Aloha Boat Charters via:

           *U.S. Registered Mail  ___

                        Other (note)______________________________________________

                   *Neither the Company nor Aloha Boat Charters is responsible for any loss or damage of cremated remains shipped via Registered Mail with the United States Postal Service.

            If no specific instructions are provided herein, Burial at Sea will be performed by the Company, at the discretion and convenience of the Company.

             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, Aloha Boat Charters reserves the right, at its discretion, to dispose of the container which contained said remains.  The obligation of the Company shall be limited to the disposition of the cremated remains as directed herein.  I/We agree to release and hold the Company 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.

           _________________________ _____________________ ______________________

            Signature                                      Print Name                          Relationship to Deceased

            _________________________ _____________________ ______________________              Address                                                                                                                                                                                                                                                                                              

            _________________________ _____________________ ______________________                 DATE                

            Signature                                      Print Name                          Relationship to Deceased

            _________________________ _____________________ ______________________

                       Address                                             

                             COPY ORIGINAL TO ALOHA BOAT CHARTERS ~COPY TO FUNERAL DIRECTOR~COPY TO CLIENT