Marin Memorial Services, Inc. (415) 458-8700 http://www.marinmemorialservices.com CRD License # 871

To Whom It May Concern: We wish to extend to you our sincere condolences for your loss.

Please follow the checklist below so that we may simplify this process for you.  Fill out the “Release & Authorization to Scatter” form below  Check your VS-9 form, which should have been provided by the funeral home or crematory upon release of the ashes. . Was the VS-9 form issued in or for the State of California? If it was not please contact the Marin County Health Department at 415-499-6876 to have this changed. . In line 16 (scattering/burial at sea) it must state “Scatter at sea off of Marin County coast”. If it does not state this please contact the Marin County Health Department at 415-499-6876 to have this changed. You will need the 1705 form, which we have attached for you.  Make a copy of the “Release & Authorization to Scatter” form and the completed VS-9 form for yourself.  Include a copy of the death certificate or burial certificate!  Include a check or money order for $150 payable to Marin Memorial Services!  Remains must be packed in a sift-proof container that is sealed in a durable sift-proof outer container. (The original container provided by the crematory is sufficient.) Put the sift-proof container in a padded shipping box marked on the address side "cremated human ashes" and send via USPS registered mail.  Send all of the above items in one container to: Marin Memorial Services, Inc. 201 Mountain View Avenue! San Rafael, CA 94901

Feel free to call with any questions or desired changes. We are here to assist you in any way that we can.

Again our condolences, Marin Memorial Services Marin Memorial Services, Inc. (415) 458-8700 http://www.marinmemorialservices.com CRD License # 871

Release & Authorization to Scatter Please print clearly Name of Deceased: Sex:

Date of Birth: Date of Death: County of Death:

Name of Mortuary & license number: Funeral Director & License number:

Name of Crematory: Date Cremated:

Requested Location of Ash Scattering at Sea:

My signature certifies that I possess and represent the legal right to control the disposition of the Cremated Remains of the deceased person stated above. It is of my own free will that I have chosen to scatter the remains of this person at the pre-determined location stated above. I understand that once the cremated remains are scattered they are unrecoverable and agree that Marin Memorial Services Inc has completed its part of this agreement.

Signature(s) of persons with the right to control disposition of human remains:

Print Sign ______

______

______

______

Please print all information clearly –Commemorative certificates will be sent to this address. Name: Address:

Telephone Number: City/ State/ Zip