WPC_ T#kn}^sn V9x0pi"*j$A<3I<tmO> 0 U |SöE$$MRꩮ(,ѓ%Qt-/əJJDBp@7kDsnI>iǴ@:!!N !L)ȫx&֮ wf_ĥYLB$o=~G3Dv)ZZZȘC 5ɳ3;̃ BID)G&"^Dٿ0G61(X1E&gmP0}ntLuټR2CN~'gP&S[y(o~n~^ʸM5oIJM%ލE2. %vSM${ ,5^jm%t!ũJ?):C*8 #UNw % 0: 0V^ w4#7F mH0&d9 Z6Times New Roman RegularX($USUS., )USUS.,  _ APPOINTMENTOFAGENTTOCONTROLDISPOSITIONOFREMAINS ! ! !(#PAGE  1  (.3$ !USUS.,  Ϛ*. Ie-:i+003|xU !USUS.,  _    APPOINTMENTOFAGENTTOCONTROLDISPOSITIONOFREMAINS     I,_______________________________________________________________(yournameand  address),beingofsoundmind,willfullyandvoluntarilymakeknownmydesirethat,uponmydeath,the  dispositionofmyremainsshallbecontrolledby____________________________(nameofagent)  inaccordancewithSection711.002oftheHealthandSafetyCodeand,withrespecttothatsubject   only,Iherebyappointsuchpersonasmyagent(attorney-in-fact).   Alldecisionsmadebymyagentwithrespecttothedispositionofmyremains,includingcremation,shall   bebinding. z   SPECIALDIRECTIONS: n  Setforthbelowareanyspecialdirectionslimitingthepowergrantedtomyagent: b  _______________________________________________________________________ \  _______________________________________________________________________ V _______________________________________________________________________ P _______________________________________________________________________ J _______________________________________________________________________ D AGENT: 8 Name:__________________________________________________________________ ,| Address:________________________________________________________________ &v TelephoneNumber:________________________________________________________  p AcceptanceofAppointment:__________________________________(signatureofagent) d DateofSignature:__________________________________________________________ ^ SUCCESSORS: !R Ifmyagentdies,becomeslegallydisabled,resigns,orrefusestoact,Iherebyappointthefollowing "F persons(eachtoactaloneandsuccessively,intheordernamed)toserveasmyagent(attorney-in-fact) #@  tocontrolthedispositionofmyremainsasauthorizedbythisdocument: $: ! 1.FirstSuccessor &."# Name:__________________________________________________________________ ("$% Address:________________________________________________________________ )%& TelephoneNumber:________________________________________________________ *&' AcceptanceofAppointment:__________________________________(signatureoffirstsuccessor) +'( DateofSignature:__________________________________________________________ -)* Ї2.SecondSuccessor  Name:__________________________________________________________________  Address:________________________________________________________________  TelephoneNumber:________________________________________________________  AcceptanceofAppointment:________________________________(signatureofsecondsuccessor)   DateofSignature:__________________________________________________________   DURATION: z   Thisappointmentbecomeseffectiveuponmydeath. n  PRIORAPPOINTMENTSREVOKED: b  Iherebyrevokeanypriorappointmentofanypersontocontrolthedispositionofmyremains. V RELIANCE: J Iherebyagreethatanycemeteryorganization,businessoperatingacrematoryorcolumbariumorboth, > funeraldirectororembalmer,orfuneralestablishmentwhoreceivesacopyofthisdocumentmayact 8 underit.Anymodificationorrevocationofthisdocumentisnoteffectiveastoanysuchpartyuntilthat 2 partyreceivesactualnoticeofthemodificationorrevocation.Nosuchpartyshallbeliablebecauseof ,| relianceonacopyofthisdocument. &v ASSUMPTION: j THEAGENT,ANDEACHSUCCESSORAGENT,BYACCEPTINGTHISAPPOINTMENT, ^ ASSUMESTHEOBLIGATIONSPROVIDEDIN,ANDISBOUNDBYTHEPROVISIONSOF,  X SECTION711.002OFTHEHEALTHANDSAFETYCODE. !R Signedthis_________________dayof__________________________,19___. "F _ __________________________________________________________(yoursignature) $: !  +'( Stateof________________  Countyof______________  Thisdocumentwasacknowledgedbeforemeon___________________________(date)by  ________________________________________(nameofprincipal).  ____________________________________________(signatureofnotarialofficer)   (Seal,ifany,ofnotary)   _____________________________________________(printedname) t  Mycommissionexpires:______________________________________ h