Authorization for Scattering

 Your Name:__________________________________________________________________

Full Address:____________________________________________________Zip__________

Phone #:______________________________e-mail:_________________________________

Date of Scattering:______________________Time of Scattering________________________

Alternate Date:__________________________Alternate Time:_________________________

Location of Scattering:_________________________________________________________

Coordinates: Latitude_______________________Longitude___________________________

I hereby authorize Air Legacy, LLC to scatter in accordance with the terms and conditions described in this
Authorization for the Scattering of Cremated Remains, the cremated remains of:

(full name of 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 weather or unanticipated mechanical difficulties could delay the scattering of Deceased's
cremated remains beyond the date and time agreed to. Air Legacy will advise me of any such delays. Air Legacy
agrees to attempt to re-schedule the event as soon as it is practical. I acknowledge that once payment is made there
is a $150 non-refunded fee, per each attempted flight (includes flight planning, admin, airport commute, etc.).  

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 or damage to cremated remains of Deceased that may occur
during the transport of said cremated remains from point of origin to Air Legacy. Air Legacy cannot communicate
with me while in flight nor will be required to visually identify 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.

(Signature & Print):_______________________________________________________________________  

(Relationship to Deceased & Date):__________________________________________________________