STATE OF TEXAS
COUNTY OF HARRIS
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.
______________________________________
SIGNED NAME
______________________________________
BY (Power-of-Attorney's signature)
_______________________________
WITNESS #1
_______________________________
WITNESS #2
Subscribed and sworn to by _______________________________________________
as attorney-in-fact for ________________________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: