After Death Arrangements - Funeral Consumers Alliance Of Minnesota

About my instructions:



These instructions are my firm wishes.

 These instructions are my preferences. My designee or survivors may do as they think best.

Additional instructions, such as instructions for my funeral ceremony, are attached.  Yes  No

Legal Authority: Under Minnesota law, if you wish to designate a person as having the authority to control your body after

death as well as its final disposition, you must have this document signed and dated in the presence of two witnesses or a

notary public.

 In accord with Minnesota Statutes 149A.80, DEATH; RIGHT TO CONTROL AND DUTY OF DISPOSITION, I designate the

following person to have authority to control my body after death as well as its final disposition.

(Name and contact information for this person): ______________________________________________

_______________________________________________________________________________________

Signature ___________________________________________________ Date _______________________

Statement of Witnesses: I personally witnessed the signing of this document, and I certify that I am not the appointed person

having authority as described in Minnesota Statutes 149A.80.

Witness Number One: Signature________________________________________ Date: _______________

Print name ____________________________________________________________

Address _______________________________________________________________

Witness Number Two: Signature ________________________________________ Date:_______________

Print name _____________________________________________________________

Address ________________________________________________________________

Notary Public:

In my presence on _____________ (date), ________________________________________ (name)

acknowledged his or her signature on this document or acknowledged that he or she authorized the person signing this

document to sign on his or her behalf. I am not named as an agent in this document.

Signature of notary: ___________________________________________________________

Notary stamp:

 No person has been designated to have control of my body after death. (I understand that in accord with Minnesota Statutes

149A.80 Subd. 2, the descending priority of authority for final disposition of my body after death devolves upon in the order of

priority listed: my spouse; my adult child or a majority of my adult children; either of my parents; my adult sibling or a majority of my

adult siblings; my adult grandchild or a majority of my adult grandchildren; my adult nieces and nephews or an majority of them.)

Keep this form where it can be easily found.

Give copies to those who will be responsible for your arrangements.

May 2014

After Death Arrangements - Funeral Consumers Alliance Of Minnesota - 2014 Page 2