╨╧рб▒с>■  ■                                                                                                                                                                                                                                                                                                                                                                                                                                                   ¤   ■   ■     ■   ■                                                                                                                                                                                                                                                                                                                                                                                                                                       Root Entry        ▓Zд Ю╤д└O╣2║ЄV·б╦└CONTENTS     &CompObj            VSPELLING            ■   ■                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       o 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 s Name: ___________________________________________ Phone: __________________ Address: __________________________________________________________________________________ 2. Second Successor s Name: ________________________________________ Phone: __________________ Address: _________________________________________________________________________________ DURATION: This appointment becomes effective upon my death. PRIOR APPOINTMENT REVOKED: I hereby revoke any prior appointment of any person to control the disposition of my remains. Signed this _____________ day of ______________________________, 2____. _______________________________________________ (Signature of person making the appointment) STATEMENT BY WITNESS (must be 18 or older): I declare that the person who executed this document is personally known to me and appears to be of sound mind and acting of his or her free will. He or she signed (or asked another to sign for him or her) this document in my presence. Witness 1: _________________________________________________ Address: __________________________________________________ Witness 2: _________________________________________________ Address: __________________________________________________ ACCEPTANCE AND ASSUMPTION BY AGENT: 1. I have no reason to believe there has been a revocation of this appointment to control disposition of remains. 2. I hereby accept this appointment. Signed this ______ day of _____________, 2____. _________________________________________________ (signature of agent) rvices.) AGENT: Name: ______________________________________CHNKWKS &°    TEXTTEXTДFDPPFDPPFDPCFDPC STSHSTSH"DSTSHSTSHD"кSYIDSYIDю"SGP SGP #INK INK #BTEPPLC #BTECPLC "#FONTFONT:#@STRSPLC z#:FRAMFRAM┤#ИDOP DOP <$ASSIGNMENT OF AN AGENT FOR DISPOSITION OF MY REMAINS I,_________________________________________________________________________________________, (name and address) being of sound mind, willfully and voluntarily make known my desire that, upon my death, the disposition of my remains shall be controlled by __________________________________________. With respect to that subject only, I hereby appoint such person as my agent with respect to the disposition of my remains. SPECIAL DIRECTIONS: Set forth below are any special directions limiting the power granted to my agent as well as any instructions or wishes desired to be followed in the disposition of my remains: ___________________________________________________________________________________________ ___________________________________________________________________________________________ Indicate below if you have entered into a pre-funded pre-need agreement, subject to з(Section) 453 of the General Business Law for funeral merchandise or service in advance of need. ( ) No, I have not entered into a pre-funded pre-need agreement subject to з453 of the General Business Law. ( ) Yes, I have entered into a pre-funded pre-need agreement subject to з453 of the General Business Law. __________________________________________________________________________________________ (Name of funeral firm with which you entered into a pre-funded pre-need funeral agreement to provide merchandise and/or services.) AGENT: Name: ______________________________________________________ Phone Number: __________________ Address: _____________________________________________________________________________________ SUCCESSORS: If my agent dies, resigns, or is unable to act, I hereby appoint the following persons (each t0jl(P║╝F║&  ╪ Р Ц Ш ж j*,D ъдj"$Юа╪Ф$ИтфТМP4~D~АВД°ЇЇЇЇЇЇъъъЇЇъЇЇЇЇъЇЇЇ╘─╘─ЇЇЇЇЇ┤ЇкЇЇ┤┤┤┤ЇЇЪЪ─ЇЇrr(2В"'(К Xэ2 ░┌e  "Г№  "Ё∙ "Ё∙ "Ё∙"PS "°|"PS "Г№  "°|"PS "PSj╝рЦ Ш ж *,D"$6Юа╪$Итф P~Д╥жxжJxжxжxжxжЄжxжxжю, "°|$К  08, "и)$К  08. "и)$К  08. "Ё$К  08, "Ё$К  08. "И╢$К  080HTSH    List ParagraphЦHTSHBPВ. "┤!" $Ки░╕└  *ш". "┤!" $Ки░╕└  "Ё∙ *ш$КttДД ,PONTCalibriArial └  " " "F   "да"a▀Ц"pЇh"с├"Ё` "Ё`""A."@   "да"?Ы"pЇh"с├"Ё` "Ё`"."" _" _" _" _ becomes effective upon my death. PRIOR APPOINTMENT REVOKED: I hereby revoke any prior appointment of any person to control the disposition of my remains. Signed this _____________ day of _____________________■      ▓Zд Ю╤д└O╣2║Quill96 Story Group Class    Ї9▓q