Limited Durable Power Of Attorney To Make Final Arrangements Form
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I, ________________________, of _____________, Virginia, appoint my ________,
_______________________(agent), of _____________, Virginia, to serve as my agent under
this LIMITED power of attorney, with authority granted to _______________ (agent) to make
arrangements for my burial, cremation or any other disposition of my remains upon my death.
This power is not in limitation or derogation of any other agency which I may at any time grant
or have granted to _______________________(agent) or any other person or entity.
_________________________(agent) may in writing substitute any person or entity to
act as agent for me under this instrument, and the written acceptance of
_________________________(agent) affixed to any instrument of substitution shall be deemed
sufficient proof of authority by any substituted person or entity to act on my behalf, and all
references to "agent" shall conclusively be deemed to include such substituted agent.
Any funeral director, funeral service establishment, or funeral service licensee shall be
fully protected in complying with the directions of _______________________(agent), or any
person substituted by _______________________(agent), in regard to the agency herein
conferred, and shall never be liable to any other person or entity for compliance with such
instructions.
Witness the following signatures and seals this _____ day of _______________, 20___.
____________________________________(SEAL)
___________________________, Principal
Accepted:
____________________________________(SEAL)
___________________________, Agent
STATE / COMMONWEALTH OF __________________, CITY / COUNTY OF ___________:
The foregoing instrument was personally acknowledged before me this _____ day of
_________________, 20___, by ______________________, the above named principal.
My commission expires:_________. My registration number is: ____________.
__________________________________, Notary Public
STATE / COMMONWEALTH OF __________________, CITY / COUNTY OF ___________:
The foregoing instrument was personally acknowledged before me this _____ day of
_________________, 20___, by __________________, the above named agent.
My commission expires:_________. My registration number is: ____________.
__________________________________, Notary Public
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