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APPLICATION FOR DISPERSAL OF CREMATED REMAINS IN CANYON AREA OF THE FIRST UNITARIAN UNIVERSALIST CHURCH OF SAN DIEGO 



Name of Deceased_______________________________________ 

Date of Death_________________


Applicant’s Name_______________________________________________________________ 


Address_______________________________________________________________________ 


Phone_______________________________Email_____________________________________ 


Relationship to Deceased________________________________________________________

Applicant requests the permission of the Church Board of the First Unitarian Universalist Church of San Diego, for the dispersal of the deceased cremated remains in the canyon area of the Church’s property.

Applicant represents and agrees as follows:

a. Applicant has the right to control the disposition of the remains of the deceased (reference Cal. Health & Safety Code [“HSC”] § 7100).

b. The deceased was a legal member or a spouse, domestic partner, child, parent, grandchild, or sibling to a legal member of the First Unitarian Universalist Church of San Diego prior to the date of death.

c. Applicant consents that the dispersal of the deceased’s cremated remains in the canyon area may be performed in a private ceremony by a minister or officer of this church, without the attendance of the deceased’s relatives or friends.

d. If permission is granted, Applicant will secure from the local registrar (of Public Health) the necessary permit for disposition (ref HSC § 103060), will be responsible for compliance with all provisions of the permit, and will provide the Church Administrator with one completed copy of the permit.

e. Applicant acknowledges and agrees that the Church and its Board members, officers, ministers, staff, volunteers, and members are not registered under California law as Cremated Remains Disposers.

f. Applicant is aware that under State law, trespass and nuisance laws apply to the disposition of the remains.

g. Applicant understands and agrees that the canyon area is not dedicated land or a private cemetery; that the proposed dispersal will not result in dedication of the land or creation of a private cemetery; that such dispersal would give no easement or rights of unrestricted access to the land; and that permission for the requested dispersal would imply or effect no restriction of future uses, maintenance, or transfer of the property.

h. Applicant, on behalf of herself or himself and her or his agents, assigns, successors, executors, administrators, and representatives of any manner, agrees to indemnify from any and all liability, hold harmless, and defend the Church and its Board, officers, ministers, staff, volunteers, and members in the event of suit, claim, or demand arising from this dispersal and any associated activities.

Applicant acknowledges that she or he has read, understands, and agrees to all the provisions above.



Date__________________________ 


Signature__________________________________________

Application must be signed and returned to Church Administrator prior to dispersal.

-----------------------------------------------------------------------------------------


Date of dispersal ____________


By _____________________

Office use only The above application is (granted/denied) on Date ____________________


_______________________________________________________
Minister, Administrator or Officer of church (title)


First Unitarian Universalist Church of San Diego, 4190 Front Street, San Diego, CA 92103

03/18/04