Specific Power Of Attorney For Right Of Sepulcher, The Right To Choose And Control Final Disposition Of A Dead Human Body
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4SPECIFIC POWER OF ATTORNEY
FOR RIGHT OF SEPULCHER, THE RIGHT TO CHOOSE AND CONTROL FINAL DISPOSITION OF A
DEAD HUMAN BODY
BY THIS DOCUMENT IT IS HEREBY ACKNOWLEDGED,
that I, _____________________________ (“Principal”) residing at _____________________________,
______________________, _________________, U.S.A., the undersigned, do hereby appoint
_________________________________________, my _____________________________________,
of _____________________________, ______________________, _________________, U.S.A., as my
attorney-in-fact ("Agent") to exercise the powers and discretions described below.
If the Agent is unable to serve for any reason, I appoint
______________________________________________________, of
_____________________________, ______________________, _________________, U.S.A., as my
alternate or successor Agent, as the case may be to serve with the same powers and discretions.
I do not revoke any and all general powers of attorney and special powers of attorney that previously
have been signed by me, as this instrument relates only to the exercising of my right to choose and
control final disposition of my body following my death as referred to in chapter 194 Section 194.119 and
chapters 193, 333, and 436 RSMo.
My Agent shall have full power and authority to act on my behalf. This power and authority shall authorize
my Agent to manage and conduct all of my affairs and to exercise all of my legal rights and powers,
including all rights and powers that I may acquire in the future as they relate to the final disposition of my
body. My Agent's powers shall include, but not be limited to, the power to:
1. Funeral Home Contracts. To arrange and purchase funeral goods and services and to enter into
contracts with funeral homes and/or funeral home operators on my behalf and for the benefit of
myself, and in regard thereto, to execute funeral home contracts upon such terms and conditions
as my said Agent shall think fit.
2. Funeral Home Authorizations. To execute on my behalf and with my authority, all funeral home
forms, and orders, vault setting authorizations, memorial/marker installation orders, releases,
indemnifications or other documents related to the funeral rites for my body as my said Agent
shall think fit.
3. Cemetery Contracts. To arrange and purchase cemetery goods and services and to enter into
contracts with cemeteries and/or cemetery operators on my behalf and for the benefit of myself,
and in regard thereto, to execute cemetery contracts upon such terms and conditions as my said
Agent shall think fit.
4. Cemetery Authorizations. To execute on my behalf and with my authority, all interment orders,
vault setting authorizations, memorial/marker installation orders, releases, indemnifications or
other documents related to the interment my body as my said Agent shall think fit.
5. Prepayment of Arrangements. To arrange for the prepayment and/or payment of funeral and
cemetery arrangements set forth in Paragraphs 1 and 3, and to make prepayments and/or
payments for such goods and services utilizing my funds. My Agent is authorized to enter into
insurance policies and trust agreements as part of the prepayment or payment of funeral and/or
cemetery expenses.
6. Monitor Funeral Rites and Interment. To monitor the funeral rites and interment of my remains
and to undertake all actions related thereto, including, but not limited to approving or disapproving
the actions of funeral home and cemetery personnel in carrying out the funeral rites and
interment, and issuing or withholding the transfer of the burial permit to the cemetery.
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