Appendix A: autopsy and disposition of remains.
I, --, hereby nominate -- to be my agent for purposes of directing an autopsy and controlling the disposition of my remains.
I understand that my agent will be able to authorize an autopsy (an examination of my body after my death to determine the cause of my death) and to direct the disposition of my remains unless I limit that authority in this document. I also understand that my agent or any other person who directed the disposition of my remains must follow any instructions I have given in a written contact for funeral services, my will or by some other method.
(Directions: If any of the statements below reflect your desires, sign next to that statement. If none of these statements reflect your desires and you want to limit the authority of your agent to consent to an autopsy and/or to dispose of your remains, you should write your own statement. Under some circumstances, the law may require that autopsy be performed even if you have refused to authorize your agent to consent to one.)
AUTOPSY ( -- ) I hereby consent to an examination of my body after my death to determine the cause of my death. ( -- ) My agent may not authorize an autopsy. DISPOSITION OF REMAINS ( -- ) I prefer that my agent direct the disposition of my remains by the following method (check one): Burial -- Cremation -- ( -- ) My agent may not direct the disposition of my remains and I would prefer that -- (name and address) -- -- direct the disposition of my remains. ( -- ) I have prescribed the way I want my remains disposed of in (check one): -- A written contract for funeral services with -- (name of mortuary/cemetery) -- My will  Other: -- PRIOR DESIGNATIONS REVOKED ( -- ) I revoke any prior durable power of attorney for health care, designations made in regards to autopsy and/or disposition of my remains. Executed this -- day of --, 20 --, at -- -- -- Signature of Principal
CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC
State of -- ) ) SS. County of --) On -- before me, --, personally (Date) (Notary) appeared -- Signer(s) Personally known to me - OR - proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. -- Notary's Signature
IMPORTANT NOTE: This sample legal document is provided for informational purposes only and may or may not be valid in your state. This sample legal document also may not include the particular provisions you need. We strongly recommend you consult a competent family or estate planning attorney who is familiar with these issues. This sample document in no way constitutes, and should not be relied upon, as legal advice.
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|Publication:||Life Lines: Documents to Protect You and Your Family in Times of Trouble|
|Date:||Jan 1, 2003|
|Previous Article:||VII. Nomination of guardian for a minor.|
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