I, ______________________________________ , being of sound mind do hereby 
make this sworn statement to be cremated upon my death.

"I direct my executor ___________________________________, or my substitute
executor, ________________________________ , to have my remains cremated as 
soon as practical upon my death.

This statement is intended to fulfill the requirement's of Vernon's Texas 
Civil Statutes Article 912a-20 which allows a deceased person to prepare 
directions prior to his/her death to control the disposition of his/her 
body upon death.

I specifically intend that this directive shall remove any authority held by 
my next of-kin relating to the disposition of my remains upon my death.

I specifically request, and give authority, to deliver my cremated remains 
to _______________________________________________________________________ , 
or to ____________________________________________________________________ .

I also direct that my executor shall be indemnified by my estate for the 
actions he/she undertakes in good faith to fulfill this directive."

SIGNED this ____ day of ____________________ , 19 ____ in Houston, Harris 
County, Texas.


                                     ______________________________________
                                     SIGNATURE


_______________________________
WITNESS #1


_______________________________
WITNESS #2 


Subscribed and sworn to by _______________________________________________ 
and acknowledged by the witnesses ________________________________________
and _____________________________ on this ____ day of ___________ , 19____ .


                                  _________________________________________
                                  NOTARY PUBLIC IN & FOR THE STATE OF TEXAS
     (seal)                       PRINTED NAME:
                                  MY COMMISSION EXPIRES: