Authorization to Disperse CremainsLast Wish, LLC is hereby authorized to disperse the cremated remains of
____________________________________________.
The dispersal will be in compliance of all Federal, State, and Local regulations.
I (the undersigned) have the authority to make this decision.
I understand that once remains are scattered they are unrecoverable.
Last Wish, LLC is held harmless and indemnified from any damage or liability involving the dispersal of ashes.
Last Wish, LLC cannot accept any responsibility involving the cremains, until Last Wish, LLC has taken possession of the cremains.
The date (weather permitting) will be agreed upon in advance of the scattering.
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Date Signature of authorized agent_______________________________________________________________________
Print Name_______________________________________________________________________
Address_______________________________________________________________________
Phone numberPlease print out and complete this authorization and forward to:
William Fallon
Last-Wish, LLC
10 Woodlot Road
Bloomingdale, NJ 07403
Phone: 1-877-342-WISH