AUTHORIZATION TO SCATTER CREMATED REMAINS

Please Print.  A copy of this form with original signature must accompany cremains.

(The exact date, time and location are subject to change due to weather, laws,  regulations and aircraft/boat traffic.  FWAS will make every effort to meet requested time and location, however, we cannot guarantee the schedule nor can FWAS guarantee that you will be able to see the scattering.  Most scatterings over the Atlantic are held 1-3 miles offshore.  FAA regulations may restrict scattering over populated areas and all scattering missions are conducted only under "visual flight rules.")

 

Neither FWAS nor your funeral home/crematorium is responsible for any loss or damage of cremains.  If no specific instructions are provided herein, scattering will be performed at the discretion and convenience of  FWAS.   I understand that once the cremains are scattered, they are unrecoverable.  Once the scattering of cremated  remains of the deceased has been performed, FWAS reserves the right to dispose of the containers in which the cremated remains were shipped/stored.  The obligation of FWAS shall be limited to the disposition of the cremated remains as directed herein. I agree to release and hold harmless FWAS, its affiliates and their agents, employees, successors and assigns from any and all loss, damage, liability or causes of action (including attorney's fee and expenses of litigation) in connection with the disposition of these cremated remains.

 

 ____________________________________      ___________________________________   ___________

Printed Name of Person Authorizing Scattering                  Signature                                                              Date

 

Address:  ________________________________________________________________________________

 

City:  __________________________________  State:  _____   Zip _______ Phone: ________________________

Four Winds Aerial Services

Division of RL Carmichael & Assoc, Inc

PO Box 9323 Chesapeake, VA 23321

 

Ph. 757-465-5600  Fax 757-465-5636

Express Delivery Address:

Four Winds Aerial Services

RL Carmichael & Assoc, Inc

3102B Tyre Neck Rd

Portsmouth, VA 23703

I certify, warrant and represent that I have the full legal right and I hereby request and authorize R.L. Carmichael & Associates, Inc dba Four Winds Aerial Services (FWAS) to dispose the cremains of the deceased named below by aerial scattering. 

 

 _____________________________________________________________________________________________

(PRINT NAME OF DECEASED)

Location:      _____   Atlantic Ocean     _____  Chesapeake Bay     _____  Other Area (please call for pricing/approval)

Certificate Choice: 

  c  Welcome Home    c  Sunrise       c Sunset

Poem Choice: 

  c Prayer for Scattering      c  From “High Flight”         c None

PAYMENT Options:

 

Payment: c  Check      c  PayPal  Please Enter Your Email Address _______________________________________________

 

  c  Credit (Visa, Master)  ______________________________________________________   _______/_______   __________

                                                   CARD NUMBER                                                                                    EXPIRATION               3 DIGIT PIN             

    

______________________________________   X ______________________________________   _____________________

NAME                                                                                  SIGNATURE                                                                 DATE