AB984: Bill Text

AB984,8,6 I hereby designate .... (print name, address, and telephone number) to be my final disposition agent for the purpose of complying with or otherwise carrying out, in my behalf, the decisions or preferences concerning the disposition that is to be made of my body after death that are expressed in this document. If he or she is ever unable or unwilling to do so, I hereby designate .... (print name, address, and telephone number) to be my alternate final disposition agent for the purpose of complying with or otherwise carrying out, in my behalf, the decisions or preferences concerning the disposition that is to be made of my body after death that are expressed in this document.

General statement of authority granted

AB984,8,7 Upon my death,

AB984,8,10 .... I authorize my final disposition agent to make all decisions concerning the disposition that is to be made of my body after death, unless the decisions exceed available resources from my estate.

AB984,8,11 OR

AB984,8,16 .... I authorize my final disposition agent to comply with or otherwise carry out my following decisions or preferences concerning the disposition that is to be made of my body after death, unless the decisions or preferences that I express exceed available resources from my estate or there is no realistic possibility of compliance with the decisions or desires:

AB984,8,17 1. Arrangements for a viewing .... (print decisions and preferences).

AB984,8,19 2. Funeral ceremony, memorial service, graveside service, or other last rite .... (print decisions and preferences).

AB984,8,21 3. Burial, cremation and burial or other disposition, or donation of my body after death .... (print decisions and preferences).

AB984,8,23 4. Any additional desires, special provisions, or limitations .... (print decisions and preferences).

OR

AB984,9,6 .... Although I do not wish to authorize a specific final disposition agent to comply with or otherwise carry out my decisions and preferences concerning the disposition that is to be made of my body after death, the following are my decisions and preferences, unless the decisions or preferences that I express exceed available resources from my estate or there is no realistic possibility of compliance with the decisions or desires:

AB984,9,7 1. Arrangements for a viewing .... (print decisions and preferences).

AB984,9,9 2. Funeral ceremony, memorial service, graveside service, or other last rite .... (print decisions and preferences).

AB984,9,11 3. Burial, cremation and burial or other disposition, or donation of my body after death .... (print decisions and preferences).

AB984,9,13 4. Any additional desires, special provisions, or limitations .... (print decisions and preferences).

AB984,9,14 (The declarant and the witnesses must sign the document at the same time.)

Signature of declarant

(Person creating the declaration of final disposition)

AB984,9,15 Signature............................................................Date...........................................

AB984,9,17 (The signing of this document by the declarant revokes all previous declarations of final disposition.)

Statement of witnesses

AB984,9,20 I know the declarant personally and I believe him or her to be of sound mind and at least 18 years of age. I believe that his or her execution of this declaration of final disposition is voluntary. I am at least 18 years of age.

AB984,9,21 Witness No. l:

AB984,9,22 (print) Name.................................................Date.................................................

AB984,10,1 Address..................................................................................................................

AB984,10,2 Signature...............................................................................................................

AB984,10,3 Witness No. 2:

AB984,10,4 (print) Name....................................................Date..............................................

AB984,10,5 Address..................................................................................................................

AB984,10,6 Signature...............................................................................................................

Statement of final disposition agent and alternate final disposition agent

AB984,10,10 I understand that .... (name of declarant) has designated me to be his or her final disposition agent or alternate final disposition agent after his or her death. .... (name of declarant) has discussed his or her decisions and preferences regarding final disposition with me.

AB984,10,11 Agent's signature...................................................................................................

AB984,10,12 Alternate's signature............................................................................................

Anatomical gifts (Optional)

AB984,10,13 Upon my death:

AB984,10,16 .... I wish to donate only the following organs or parts:.............................................................................................................................. (specify the organs or parts).

AB984,10,17 .... I wish to donate any needed organ or part.

AB984,10,18 .... I wish to donate my body for anatomical study if needed.

AB984,10,21 .... I refuse to make an anatomical gift. (If this revokes a prior commitment that I have made to make an anatomical gift to a designated donee, I will attempt to notify the donee to which or to whom I agreed to donate.)

AB984,10,23 Failing to check any of the lines immediately above creates no presumption about my desire to make or refuse to make an anatomical gift.

AB984,11,1 Signature...............................................................................................................

AB984,11,2 Date........................................................................................................................

AB984,11,10 154.36 Anatomical gift. A declarant may, if the requirements of s. 157.06 (2) are met, make, or refuse to make, an anatomical gift in a declaration of final disposition. An anatomical gift that is made in a declaration of final disposition supercedes a prior, conflicting, unrevoked anatomical gift or a prior, unrevoked refusal to make an anatomical gift made by the declarant under s. 157.06 (2). A refusal to make an anatomical gift that is made in a declaration of final disposition supercedes a prior, conflicting, unrevoked anatomical gift made by the declarant under s. 157.06 (2).

AB984,11,14 154.38 Reports of death, autopsies, inquests. This subchapter is subject to the powers and duties of coroners, medical examiners, and other physicians licensed to perform autopsies with respect to the reporting of certain deaths, performance of autopsies, and inquests under ch. 979.

AB984,11,16 154.40 Revocation of declaration. A declarant may revoke a declaration of final disposition at any time by any of the following methods:

AB984,11,20 (1) Canceling, defacing, obliterating, burning, tearing, or otherwise destroying the declaration of final disposition or directing some other person to cancel, deface, obliterate, burn, tear, or otherwise destroy the declaration of final disposition in the presence of the declarant.

AB984,11,22 (2) Revoking in writing the declaration of final disposition. The declarant shall sign and date any written revocation under this subsection.

AB984,11,23 (3) Executing a subsequent declaration of final disposition.

AB984,12,3 154.42 Immunities. (1) No funeral director, cemetery, crematory authority, final disposition agent, or alternate final disposition agent may be held civilly or criminally liable, or charged with unprofessional conduct, for any of the following:

AB984,12,5 (a) Complying with or otherwise carrying out, in good faith, the decisions or preferences expressed in a declaration of final disposition.

AB984,12,7 (b) Failing to act upon a revocation of a declaration of final disposition unless the person or facility has actual knowledge of the revocation.

AB984,12,11 (2) No individual who acts in good faith as a witness to a declaration of final disposition under this subchapter may be held civilly or criminally liable for complying with or otherwise carrying out the decisions or preferences expressed in the declaration.

AB984,12,15 154.44 Penalties. (1) Any person who intentionally conceals, cancels, defaces, obliterates, or damages the declaration of final disposition of another without the declarant's consent may be fined not more than $500 or imprisoned not more than 30 days or both.

AB984,12,20 (2) Any person who knowingly disposes of a body in a manner that is inconsistent with a declaration, unless the decisions or preferences expressed by the declarant exceed available resources from the declarant's estate or if there is no realistic possibility of compliance with the decisions or preferences, may be fined not more than $500 or imprisoned not more than 30 days or both.

AB984,12,21 (End)