§ 5-33.3-4 - Form of designation.
SECTION 5-33.3-4
§ 5-33.3-4 Form of designation. – (a) The designation provided for in section 5-33.3-3 may be in substantiallythe following form:
I, (PRINCIPAL), do hereby name and designate (PRIMARY AGENT)as my primary funeral planning agent, or if he/she is unwilling or incapable(ALTERNATE AGENT) as my alternate funeral planning agent, who shall have thesole responsibility and authority to make any and all arrangements anddecisions regarding my funeral preparation and planning, burial or dispositionof my remains, including cremation, upon my death, pursuant to the provisionsof § 5-33.2-24. By signing this document, the aforementioned agent(s)agree to ensure payment for all outstanding expenses related to my funeral. Theagent further certifies that if I am a non-relative to the agent, then I am theonly non-relative for whom the agent is serving as a funeral planning agent.This document shall revoke and shall make null and void any and all previousdesignations of a funeral planning agent.
Witness: ]]]]]]]]]]]]]]]]]] Principal:
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(Name and address of Witness) ]]]] Name and address ofPrincipal:
Dated: ]]]]]]]]]]]]]] Dated:
Primary Agent: ]]]]]]]]]]]]]] Alternate Agent:
Name and Address of Primary Agent Name and Address ofAlternate Agent
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Dated: ]]]]]]]]]]]]]] Dated
State of ]]]]]]]]]]]]]]]]]] County of
Subscribed and sworn to before me this ]]]]]]]] day of
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]]]]]]]]]]]]]]]]]]]]]]]] (Notary Public)
(b) Upon the proper and complete execution of a funeralplanning agent designation form, a signed notarized original thereof shall begiven to the principal executing the form, the primary funeral planning agent,and the alternate funeral planning agent, if any.
(c) The principal is encouraged to review in detail his orher specific wishes regarding the nature of the funeral goods and services tobe provided, the manner in which funeral services are to be conducted, and/orthe disposition of his or her remains with their funeral planning agent(s).
(d) This chapter shall not be construed to prohibit theparticipation of other individuals in the funeral planning process as well asthe funeral itself. No individuals shall be required to designate a funeralplanning agent under the provisions of this chapter.