______________________________________________________________________________
APPOINTMENT OF PERSON
TO MAKE DECISIONS
CONCERNING DISPOSITION
OF REMAINS
I, __________________, appoint __________________, whose address is _______________ and whose telephone number is (___) _________, as the person to make all decisions regarding the disposition of my remains upon my death for my burial, cremation or alternative disposition. In the event ____________ is unable to act, I appoint ____________, whose address is __________________ and whose telephone number is (___) _________, as my alternate person to make all decisions regarding the disposition of my remains upon my death for my burial, cremation or alternative disposition.
It is my intent that this Appointment of Person to Make Decisions Concerning Disposition of Remains act as and be accepted as the written authorization presently required by ORS 97.130 (or its corresponding future provisions) or any other provision of Oregon Law, authorizing me to name a person to have authority to dispose of my remains.
DATED this ___ day of ______, _____.
__________________
(Signature)
NOTARY OR WITNESSES
(Have this document notarized by a notary public OR have 2 competent adult witnesses complete the Declaration of Witnesses.)
NOTARIAL CERTIFICATE:
State of ____________
County of ____________
Signed or attested before me on _____,
2___, by _______________.
________________________
Notary Public - State of Oregon
OR
DECLARATION OF WITNESSES
We declare that ____________ is personally known to us, that he/she signed this Appointment of Person to Make Decisions Concerning Disposition of Remains in our presence, that he/she appeared to be of sound mind and not acting under duress, fraud or undue influence, and that neither of us is the person so appointed by this document.
Witnessed By:
_______________ Date: _____
Witnessed By:
_______________ Date: _____
______________________________________________________________________________
ORS 97.130