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Appointment of Agent Form

An Agent is the individual who will be handling the funeral.

Appointment of Agent to control Disposition of Remains

  • This document shall constitute the "written instrument" asprovided in Section 42or of the NYS Public Health Law
  • I,
  • being of sound mind, willfully and voluntarily make known my desire that, upon my death, the disposition of my remains shall be controlled by:
  • With respect to that subject only, I hereby appoint such person as my age with respect to the disposition of my remains.
  • A. SPECIAL DIRECTIONS

  • B. AGENT INFORMATION

  • C. SUCCESSORS

  • If my agent dies, resigns, or is unable or unwilling to act, I hereby 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:
  • D. DURATION

    This appointment becomes effective upon my death.
  • E. PRIOR APPOINTMENT REVOKED

    I hereby revoke any prior appointment of any person to control the disposition of my remains.
  • I hereby revoke any prior appointment of any person to control the disposition of my remains