Your Full Address:__________________________________Zip:_____________________
Your Phone #:_________________________e-mail:_______________________________
Date of Scattering:______________________Time of Scattering______________________
Alternate Date:___________________________Alternate Time:______________________
Location of Scattering:_______________________________________________________
Coordinates (if known) Latitude___________________Longitude_____________________
I hereby authorize Air Legacy, LLC to scatter in accordance with the terms and conditions described in this Authorization for the Aerial Scattering of Cremated Remains the cremated remains of
(full name of the deceased) _______________________________ (hereinafter "Deceased")
from an aircraft at an altitude and location deemed both safe and in compliance with all applicable laws and regulations governing such action. I certify that I hold full legal right and authority to control the transportation and final disposition of the cremated remains of Deceased and that the identity of said remains is as stated above.
I understand that factors such as weather or unanticipated mechanical difficulties could delay the scattering of Deceased's cremated remains beyond the date and time agreed to between myself and Air Legacy and that Air Legacy will advise me of any such delays. Air Legacy then agrees to attempt to reschedule the event as soon as it is practical. I acknowledge that there is a $100 non-refunded fee, per attempt, for flight planning & attempted flights.
I agree to hold harmless and indemnify Air Legacy and it's principals, employees, agents and affiliates from any claims, demands or damages that may be made arising from the aerial scattering of cremated remains described and authorized herein.
I understand and agree that the scattering of the cremated remains of Deceased is a final and irrevocable act and that once complete the cremated remains will not be recoverable.
I agree that Air Legacy is not responsible for any loss of, or damage to, cremated remains of Deceased that may occur during the transport of said cremated remains from point of origin to Air Legacy. Additionally, Air Legacy will not be required to visually identify me and my party on the ground. Air Legacy will commence the scattering at the appointed place & time indicated above.
This Authorization and the agreements that it constitutes shall be considered in accordance with the laws of the State of Colorado and any disputes arising hereunder shall be adjudicated in the State of Colorado.
Authorized by: (Signature & Print)_______________________________________________________
(Relationship to Deceased & Date):_______________________________________________________