A disposition document must be in substantially the following form:
DISPOSITION DOCUMENT
You can select Part 1, Part 2, or both, by completing the part(s)
you select, including providing any signatures indicated. Part 3
contains general statements and a place for your signature. You must
sign in front of a notary.
PART 1. APPOINTMENT OF AGENT TO CONTROL DISPOSITION OF REMAINS. If
you appoint an agent, you and your agent must complete this part as
indicated, and the agent must sign this part.
I, , being of sound mind, wilfully and voluntarily make known my
desire that, on my death, the disposition of my remains shall be
controlled by (name of agent first named below), and, with respect to
that subject only, I appoint that person as my agent. All decisions
made by my agent with respect to the disposition of my remains,
including cremation, are binding.
ACCEPTANCE BY AGENT OF APPOINTMENT.
THE AGENT, AND EACH SUCCESSOR AGENT, BY ACCEPTING THIS APPOINTMENT,
AGREES TO AND ASSUMES THE OBLIGATIONS PROVIDED IN THIS DOCUMENT. AN
AGENT MAY SIGN AT ANY TIME, BUT AN AGENT'S AUTHORITY TO ACT IS NOT
EFFECTIVE UNTIL THE AGENT SIGNS BELOW TO INDICATE THE ACCEPTANCE OF
APPOINTMENT. ANY NUMBER OF AGENTS MAY SIGN, BUT ONLY THE SIGNATURE OF
THE AGENT ACTING AT ANY TIME IS REQUIRED.
AGENT:
Name:
Address:
Telephone Number:
Signature Indicating Acceptance of Appointment:
Date of Signature:
SUCCESSORS:
If my agent dies, becomes legally disabled, resigns, or refuses to
act, I appoint the following persons (each to act alone and
successively, in the order named) to serve as my agent to control the
disposition of my remains as authorized by this document:
(1) First Successor
Name:
Address:
Telephone Number:
Signature of First Successor Indicating Acceptance of Appointment:
Date of Signature:
(2) Second Successor
Name:
Address:
Telephone Number:
Signature of Second Successor Indicating Acceptance of Appointment:
Date of Signature:
PART 2. DIRECTIONS FOR THE DISPOSITION OF MY REMAINS.
Stated below are my directions for the disposition of my remains:
If the disposition of my remains is by cremation, then (pick one):
( ) I do not wish to allow any of my survivors the option of
canceling my cremation and selecting alternative arrangements,
regardless of whether my survivors consider a change to be appropriate.
( ) I wish to allow only the survivors I have designated below
to have the option of canceling my cremation and selecting alternative
arrangements, if they consider a change to be appropriate:
PART 3. GENERAL PROVISIONS AND SIGNATURE.
WHEN DIRECTIONS BECOME EFFECTIVE. The directions, including any
appointment of an agent, in this disposition document become effective
on my death.
REVOCATION OF PRIOR APPOINTMENTS. I revoke any prior appointment of
any person to control the disposition of my remains.
SIGNATURE OF PERSON MAKING DISPOSITION DOCUMENT
Signature:
Date of signature:
(Notary acknowledgment of signature)
Section: Previous 13.75.010 13.75.020 13.75.030 13.75.040 13.75.050 13.75.060 13.75.070 13.75.080 13.75.090 13.75.100 13.75.110 13.75.120 13.75.190 13.75.195 NextLast modified: November 15, 2016