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Appendix A: autopsy and disposition of remains.

AUTOPSY AND DISPOSITION OF MY 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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No portion of this article can be reproduced without the express written permission from the copyright holder.
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Publication:Life Lines: Documents to Protect You and Your Family in Times of Trouble
Date:Jan 1, 2003
Words:490
Previous Article:VII. Nomination of guardian for a minor.
Next Article:Appendix B: hospital visitation authorization.


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