Appointment of Agent to Control Disposition of Remains Template

[Full Name]
[Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]

Date: [Date]

1. Appointment of Agent

I, [Full Name], appoint the following person as my agent to control the disposition of my remains after my death:

Agent Name: [Full Name]
Relationship: [Relationship]
Address: [Address]
Phone Number: [Phone Number]
Email Address: [Email Address]

2. Alternate Agent

If the person named above is unwilling, unavailable, or unable to act, I appoint the following alternate agent:

Alternate Agent Name: [Full Name]
Relationship: [Relationship]
Address: [Address]
Phone Number: [Phone Number]
Email Address: [Email Address]

3. Authority Granted

My agent shall have the authority to make decisions regarding the disposition of my remains, including:

☐ burial
☐ cremation
☐ donation, if permitted by law
☐ transportation of remains
☐ funeral or memorial arrangements
☐ selection of cemetery, burial site, or other final resting place
☐ related services and instructions

This authority applies to the extent allowed by applicable law.

4. Instructions and Preferences

My wishes regarding the disposition of my remains are as follows:

[Describe burial, cremation, service preferences, religious wishes, location, or other instructions]

Additional instructions, if any:

[Insert additional instructions]

5. Limitations

The authority granted to my agent is subject to the following limitations, if any:

[Insert any limits or write “None”]

6. Effectiveness

This appointment becomes effective upon my death and remains effective until my remains have been disposed of and all related arrangements under this document have been completed, unless earlier revoked according to law.

7. Revocation of Prior Appointment

I revoke any prior appointment or written designation I have made regarding the control of the disposition of my remains, to the extent permitted by law.

8. Reliance by Third Parties

Any funeral home, cemetery, crematory, hospital, or other person or entity may rely on this document as evidence of my agent’s authority, unless they have actual notice of its revocation or invalidity.

9. Governing Law

This document shall be governed by the laws of the state of [State].

10. Signature

Signature: __________________________
Name: [Full Name]
Date: [Date]

11. Agent Acknowledgment

I, [Agent Full Name], accept this appointment and understand the responsibilities described in this document.

Agent Signature: __________________________
Name: [Agent Full Name]
Date: [Date]

12. Witnesses or Notary

Witness 1 Signature: __________________________
Name: [Full Name]
Date: [Date]

Witness 2 Signature: __________________________
Name: [Full Name]
Date: [Date]

Notary, if required:

State of [State]
County of [County]

On this [Day] of [Month], [Year], before me, the undersigned notary public, personally appeared [Name of Signer], known to me or satisfactorily proven to be the person whose name is subscribed to this instrument, and acknowledged that they executed the same for the purposes stated herein.

Notary Public Signature: __________________________
Name: [Notary Name]
My Commission Expires: [Date]