§ 29-2-19-13 — Form of funeral planning declaration

The following is the funeral planning
declaration form:
Declaration made this _____ day of _______ (month, year). I,
_________, being at least eighteen (18) years of age and of sound
mind, willfully and voluntarily make known my instructions concerning
funeral services, ceremonies, and the disposition of my remains after
my death.
I hereby declare and direct that after my death
__________________(name of designee) shall, as my designee, carry
out the instructions that are set forth in this declaration. If my designee
is unwilling or unable to act, I nominate ____________ as an alternate
designee.
I hereby declare and direct that after my death the following actions
be taken (indicate your choice by initialing or making your mark before
signing this declaration):
(1) My body shall be:
(A) _______________ Buried. I direct that my body be buried
at _______________.
(B) _______________ Cremated. I direct that my cremated
remains be disposed of as follows:
________________________________________________
________________________________________________
(C) _______________ Entombed. I direct that my body be
entombed at _______________.
(D) _______________ I intentionally make no decision
concerning the disposition of my body, leaving the decision to
my designee (as named above).
(2) My arrangements shall be made as follows:
(A) I direct that funeral services be obtained from:
__________________________________________________
__________________________________________________
(B) I direct that the following ceremonial arrangements be
made:
__________________________________________________
__________________________________________________
(C) I direct the selection of a grave memorial that:
__________________________________________________
__________________________________________________
(D) I direct that the following merchandise and other property
be selected for the disposition of my remains, my funeral or
other ceremonial arrangements:
_________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
(E) __________________I direct that my designee (as named
above) make all arrangements concerning ceremonies and other
funeral services.
(3) In addition to the instructions listed above, I request the
following:
__________________________________________________
__________________________________________________
(4) If it is impossible to make an arrangement specified in
subdivisions (1) through (3) because:
(A) a funeral home or other service provider is out of business,
impossible to locate, or otherwise unable to provide the
specified service; or
(B) the specified arrangement is impossible, impractical, or
illegal;
I direct my designee to make alternate arrangements to the best of
the designee's ability.
It is my intention that this declaration be honored by my family and
others as the final expression of my intentions concerning my funeral
and the disposition of my body after my death. I understand the full
import of this declaration.
The declarant is personally known to me, and I believe the declarant
to be of sound mind. I did not sign the declarant's signature above for
or at the direction of the declarant. I am not a parent, spouse, or child
of the declarant. I am not entitled to any part of the declarant's estate.
I am competent and at least eighteen (18) years of age.
Witness _______________ Date __________
Witness _______________ Date __________

Legislative History

As added by P.L.143-2009, SEC.14.