The following declaration of disposition of last remains must be substantially in the following form:

DECLARATION OF DISPOSITION OF LAST REMAINS

I, ________________________________ (Name of Declarant), being of sound mind and lawful age, hereby revoke all prior declarations, wills, codicils, trusts, powers of appointment, and powers of attorney regarding the disposition of my last remains, and I declare and direct that after my death the following provisions be taken:

1. If permitted by law, my body shall be (Initial ONE choice):

____ Buried. I direct that my body be buried at .

____ Cremated. I direct that my cremated remains be disposed of as follows:

.

____ Entombed. I direct that my body be entombed at .

____ Other. I direct that my body be disposed of as follows:

____ Disposed of as ____________ (Name of Designee) shall decide in writing. If ____________ is unwilling or unable to act, I nominate ____________ as my alternate designee.

2. I request that the following ceremonial arrangements be made (initial desired choice or choices):

____ I request ____________ (Name of designee) make all arrangements for any ceremonies, consistent with my directions set forth in this declaration. If ____________ is unwilling or unable to act, I nominate ____________ as my alternate designee.

____ Funeral. I request the following arrangements for my funeral:

.

____ Memorial Service. I request the following arrangements for my memorial service:

.

3. Special Instructions. In addition to the instructions above, I request (on the following lines you may make special requests regarding ceremonies or lack of ceremonies):

.

Note:

I may revoke or amend this declaration in writing at any time. I agree that a third party who receives a copy of this declaration may act according to it. Revocation of this declaration is not effective as to a third party until the third party learns of my revocation. My estate shall indemnify any third party for costs incurred as a result of claims that arise against the third party because of good-faith reliance on this declaration.

I execute this declaration as my free and voluntary act, on ________________.

_____________ (Declarant) ________________________________.

The following section regarding organ and tissue donation is optional. To make a donation, initial the option you select and sign below.

In the hope that I might help others, I hereby make an anatomical gift, to be effective upon my death, of:

A. ____ Any needed organs/tissues.

B. ____ The following organs/tissues:

.

Donor signature:

Notarization Optional:

State of Delaware

County of ________________ :

Acknowledged before me by ________________________________, Declarant, on ________, ____ . My commission expires:

*(Seal) Notary Public .

74 Del. Laws, c. 295, § 1.