$49.95

Add to cart

Oklahoma ic) _________________________________ Name typed, printed, or stamped -6- them is related to the principal by blood or marriage, or related to the attorney-in-fact by blood or marriage. _________________________________ Signature of person taking acknowledgment (Notary Publd it as the free act and deed of the principal for the purposes expressed in the document, and the witnesses declared to me that they were each eighteen (18) years of age or over, and that neither of duly sworn, the principal declared to me and to the witnesses in my presence that the instrument is his or her power of attorney, and that the principal has willingly and voluntarily made and execute____________ (Witness), and ___________________________________ (Witness), whose names are signed to the foregoing instrument in their respective capacities, and all of these persons being by me -5- _____________________ ) Before me, the undersigned authority, on this ______day of _________________, ______, personally appeared _________________________________ (principal), ___________________________________________________ State: ___________________________________ * witnesses may not be under 18 or related by blood or marriage to the Principal or Agent State of OKLAHOMA ) ) ss County of ________ City: __________________________________ State: ___________________________________ Witness Signature*: ___________________________________ Name: ___________________________________ City: ______ngly made and executed it as his or her free and voluntary act for the purposes expressed in this document. Witness Signature*: ___________________________________ Name: ______________________________rincipal has declared to me that this instrument is his or her power of attorney granting to the named attorney-in-fact the power and authority specified in this document, and that he or she has williieve the principal to be of sound mind. I am eighteen (18) years of age or older. I am not related to the principal by blood or marriage, or related to the attorney-in-fact by blood or marriage. The pe to my Agent. Signed on ________________ (date), at _______________________ (city), Oklahoma. ________________________________ Signature of Principal The principal is personally known to me and I belary duty, failure to act in good faith and/or willful misconduct, while acting under the authority of this Power of Attorney. I may revoke this Power of Attorney at any time by providing written noticout notice of such termination, shall be held harmless. -4- Agent shall not be liable for losses resulting from judgment errors made in good faith. However, Agent will be liable for breach of fiducithird party because of reliance on this power of attorney. If this Durable Power of Attorney is terminated by operation of law, any person relying in good faith on the authority of this document, with of the power of attorney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree to indemnify the third party for any claims that arise against the s I may own on the life of my Agent; and/or (c) my assets to be subject to a general power of appointment by my Agent. Any third party who receives a copy of this document may act under it. Revocationy this power-of-attorney are limited to the extent necessary to prevent (a) my income to be taxable to my Agent; (b) my Agent to have any rights or ownership with respect to any life insurance policien needs to inquire as to the reasons for the use or issuance of this power-ofattorney or as to the disposition of any proceeds paid to my Agent based on this document. The powers granted to my Agent b, illegal or unenforceable under applicable law, then the remaining unaffected parts of the document shall still remain in full force and effect and not be affected by any partial invalidity. No persosting of specific terms, rights, acts or powers are not intended to restrict or limit the definition or scope of powers granted herein in any manner. If any part of this document is held to be invalidon my behalf, my Agent shall provide an accounting for all funds handled and all acts performed as my Agent. This Power of Attorney shall be construed as broadly as a General Power of Attorney. The liy. If desired, my Agent shall also be entitled to reasonable compensation for any services provided as my Agent If so requested by myself or any authorized personal representative or fiduciary acting as certified in writing by a licensed medical doctor. My Agent shall be entitled to reimbursement of all reasonable expenses incurred as a result of carrying out any provision of this Power of Attornein, "disability" or "incapacity" shall mean a lack of capacity to receive and evaluate information effectively, to communicate decisions, and/or to manage my financial resources and affairs properly, t thereafter until my death. This Power of Attorney shall not terminate on my subsequent disability, incapacity or lack of mental competence, except as provided by any applicable statute. As used herecome effective upon my subsequent disability or incapacity as certified in writing by a licensed medical doctor. The rights, powers, and authority of this document shall remain in full force and effecI would be entitled, if the result is that the disclaimed assets pass directly or indirectly to my Agent or my Agent's estate. This Durable Power of Attorney and all rights and powers therein shall beof this document), which might be transferred or distributed to me from any other person, estate, trust, or other entity, as may be appropriate. However, Agent may not disclaim assets, to -3- which ort. 16. To transfer any of my assets to the trustee of any revocable trust created by me, if such trust exists at the time of such transfer. 17. To disclaim any interest (subject to other provisions or (c) use any of my assets to discharge any of my Agent's legal obligations, including any obligations of support which my Agent may owe to others, excluding those whom I am legally obligated to suppeditors, or the creditors of my Agent's estate, (b) exercise any powers of appointment I may hold in favor of my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, ot, unless specifically authorized by this document, (a) gift, appoint, assign or designate any of my assets, interests or rights, directly or indirectly, to my Agent, my Agent's estate, my Agent's cr in value the federal gift tax annual exclusion amount in any one calendar year, and this annual right shall be non-cumulative and shall lapse at the end of each calendar year. However, my Agent may nor pursuant to the Uniform Gifts to Minors Act or the Uniform Transfers To Minors Act. Any gifts made shall be limited to gifts that qualify for the federal gift tax annual exclusion, shall not exceedanning or otherwise, and if necessary, to file any state and federal gift tax returns and documents. Gifts to minors may be made to the minor directly or parent, guardian or close friend of the minor . 15. To make gifts and charitable contributions of my real, personal, tangible or intangible property, to such persons or organizations without regard to whether such gifts are a part of my estate pl related documents; to obtain or provide information to and from any agency, including governmental agencies, relating to tax matters and to negotiate, compromise or settle any matter with such agencyed, sign, and/or file any documents with any federal, state, local or other governmental body, including, but not limited to, federal, state, local or other income and tax returns and necessary and/or and/or business assistance as may be appropriate, including but not limited to, attorneys, accountants, investment professionals, brokers and real estate agents. 14. To prepare, or cause to be prepartions or any other investments. 12. To maintain and/or operate any business that I currently own or have an interest in or may own or have an interest in, in the future. 13. To employ any professionalheir contents, and to examine, remove, keep or otherwise dispose of the contents. 11. To exercise any and all rights, including proxy rights, with respect to stocks, bonds, debentures, commodities, opuding U.S. Treasury Securities. -2- 10. To have access to any safe deposit box, vault or other storage area owned or leased by me alone or in conjunction with any other person, including access to table to me by any person, firm, corporation or political entity; to perform any act necessary to deposit, negotiate, sell or transfer any note, security, or draft of the United States of America, inclsits and withdrawals, negotiating or endorsing any checks or other instruments, obtaining bank statements, passbooks, drafts, warrants, money orders, certificates, cashier checks, cash or vouchers payand other similar accounts with financial institutions; to conduct any business with any banking or financial institution with respect to any of my accounts, including, but not limited to, making depon, maintain and/or close bank accounts, including, but not limited to, checking accounts, savings accounts, certificates of deposit, investment accounts, brokerage accounts, retirement plan accounts, ted to, medical, military and social security benefits), and to appoint anyone, including my Agent, to act as my "Representative Payee" for the purpose of receiving Social Security benefits. 9. To ope and Medicare; to prepare applications, provide information, and perform any other reasonable request by any government or its agencies in connection with governmental benefits (including but not limi and/or sue to recover all payments I receive from any annuity, pension, retirement benefits, retirement plans, insurance benefits and government program including, but not limited to, Social Securitylicies, including life insurance upon my life or the life of any other appropriate person and to make any elections and disclaimers under such policies. 8. To receive, deposit, hold, demand, deal witht, recover and receive all monies which may become due and owing to me by reason of such transaction. 7. To apply for, purchase, maintain and/or deal with insurance and annuity contracts, insurance pos includes the right to sell or encumber any homestead that I now own or may own in the future; the right to remove tenants and to recover possession; and the right to ask for, demand, sue for, collecy real or personal property or asset whatsoever, tangible or intangible (now owned or acquired in the future by me) and to execute any necessary document, instrument or deed for such transactions. Thie, lease, rent, sell, mortgage, improve, repair, exchange, invest, reinvest and in any other manner (on such terms and at prices my Agent may deem proper) deal with all, any part or any interest in anto or disputed, now due or due in the future, owned by, due, owing payable, or belonging to, me or in which I have or may hereafter acquire any interest, to have, or use. 6. To maintain, manage, insurs, commercial papers, checks, drafts, causes of action, bequests, deposits, notes, interests, dividends, certificates of deposit, any and all documents of title and demands whatsoever, whether agreed mpromise and settle any claim, against me or asserted on my behalf against any other person or entity. -1- 5. To receive, hold, possess and/or invest any and all sums of money, accounts, debts, bondents in writing of whatever kind and nature as may be. 3. To request, ask, demand, sue and take any and all legal steps necessary to recover and collect any amount or debt owed to me. 4. To adjust, coompanies or other institutions, proofs of loss, evidences of debts, releases, and satisfaction of mortgages, lien, judgments, security agreements and other debts and obligations and such other instrumedit, stock certificates, proxies, warrants, commercial papers, withdrawal and deposit slips, certificates of deposit of, or investments with or through banks, savings and loan, brokers, mutual fund cding, bonds, contracts, covenants, conveyances, deeds, options, trust deeds, security agreements, leases, mortgages, notes, insurance policies, receipts, title documents, checks, drafts, letters of cr to sign, endorse and execute any written agreement and document necessary to enter into any such contract and/or agreement, including but not limited to applications, assignments, bills of sale or la, but not be limited to: 1. To conduct, engage in, and transact any and all lawful business of whatever kind or nature, on my behalf and in my name. 2. To enter into binding contracts on my behalf andy Agent, or my Agent's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights hereby granted. My Agent's powers and authority shall includeny person, item, transaction, thing, business, property, real or personal, tangible or intangible, or matter whatsoever as I could do if personally present. I hereby ratify and confirm all acts that mdiscretions. My Agent shall have full power and authority to perform any act, power, duty, legal right or obligation whatsoever that I now have or may later acquire in connection with or relating to a__________________________ maintaining an address at: _____________________________________________________ as my alternate or successor Agent, as necessary, to serve with the same powers, rights and _________________________________________ my true and lawful attorney-in-fact for me and in my name, and in my behalf. If the above named Agent is unable to serve for any reason, I appoint ___________ncipal") maintaining an address at _______________________________________________ do hereby make and appoint ________________________________________ ("Agent") maintaining an address at: ____________ciary and other legal responsibilities of an agent. -3- OKLAHOMA DURABLE POWER OF ATTORNEY Effective upon Disability KNOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Pri make medical and other health-care decisions for you. You may revoke this power of attorney if you later wish to do so. AGENT: By accepting or acting under the appointment, the agent assumes the fiduithin the scope of this power of attorney document, is legally binding upon you. If you have any questions about these powers, obtain competent legal advice. This document does not authorize anyone tother person ("agent") with the power to handle business and legal matters on your behalf, including the power to sell, mortgage or dispose of your property. Any such action undertaken by your agent, wns. -2- CAUTION! PRINCIPAL: The Powers granted by this power of attorney document are broad and sweeping. Before signing this document, consider its consequences. You ("principal") are providing anohis information is general information that is not state specific. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific instructioo so. Two witnesses are necessary, if the Agent will deal with any real estate in Florida. Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, tlow the Durable Power of Attorney to be recorded as a public record, if necessary. Although, some states don't require that a Durable Power of Attorney be witnessed, it is always a very good idea to d require it, especially if the Agent will be dealing with any real property. Notarization will make it more difficult for any third party to challenge the validity of the Power of Attorney and will als Power of Attorney is signed, in the event the original Agent is unable to serve or continue to serve as the Agent. A Durable Power of Attorney should always be notarized, even if your state does notDurable Power of Attorney at any time. Since this Durable Power of Attorney takes effect only after the Principal becomes disabled or incompetent, an alternate Agent can be designated, at the time thily binding upon the Principal. This is especially important if the Principal is incapacitated when the Power of Attorney goes into effect, or the Agent undertakes the acts. The Principal can revoke a power of attorney. A Power of Attorney is a "powerful" instrument and should be granted with care. Any action undertaken by the Agent, within the scope of the Power of Attorney document, will be legalhe word "attorney" is not used here to mean "lawyer". The person acting as the attorney-in-fact for the Principal does not need to be a lawyer. Almost anyone can be appointed an attorney-in-fact by a AttorneyIn-Fact") to act on his or her behalf, even if the Principal later becomes incapacitated. This particular Form becomes effective upon the disability or incapacity of the Principal. Note that t Attorney Effective upon Disability A Durable Power of Attorney allows a natural "mentally competent " person (called the "Principal" or "Principal") to authorize someone else (called the "Agent" or "before negotiating a document with another party. [_] The purchase and use of these forms, is subject to the Disclaimers and Terms of Use found at findlegalforms.com -1- Information Durable Power oftended and are not a substitute for legal advice. These forms should only be a starting point for you and should not be used without consulting with an attorney first. An Attorney should be consulted at the first choice as Agent is unable to serve or continue to serve as the Agent. This section can be removed, deleted (and initialed) or the words "no one" can be entered. [_] These forms are not invery broad and sweeping, as the Agent has the power to handle business and legal matters on the Principal's behalf. [_] This document offers the option of nominating an alternate Agent in the event thn instructing the Agent (or attorney-in-fact) as to the tasks the Agent should complete. The Grantor should also be very careful in the selection of the Agent. The powers granted by this document are o the Principal or Agent. [_] The Principal should keep the original document, as well as a copy. The Agent should have access to the original document as needed. [_] The Principal should be careful i public record, if necessary. [_] In Oklahoma, two witnesses also need to sign the Power of Attorney at the same time as the Notary. The witnesses may not be under 18 or related by blood or marriage tof the Principal. [_] The Principal (i.e. the person granting the Power of Attorney) should sign the document before a Notary. Notarization will allow the Durable Power of Attorney to be recorded as a) Information for Durable Power of Attorney Effective upon Disability; (3) Durable Power of Attorney Effective upon Disability [_] This Durable Power of Attorney becomes effective upon the Disability Instructions & Checklist Oklahoma Durable Power of Attorney Effective upon Disability [_] This package contains (1) Instructions & Checklist for Durable Power of Attorney Effective upon Disability; (2 OklahomaOklahoma of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature __________________________________ (Seal) t and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf________________________________ ___________, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrumen__________ before me, (here insert name and title of the officer), personally appeared ________________________________________________________________________ ________________________________________________ Names of institutions/individuals who have been provided a copy of this revocation: Notary Acknowledgment State of __________________________ County of ________________________ ) ) ss ) On ______ State:_________________________ Witness Signature:__________________ Date: ___________________________ Name: ___________________________ City: _________________________ State:_________________ ___________________ (date). _____________________________ Principal Witness Signature:__________________ Date: ___________________________ Name: ___________________________ City: ___________________ artificial life sustaining procedures is revoked and withdrawn and this document provides notice of such revocation. IN WITNESS WHEREOF, I have signed this Health Care Power of Attorney Revocation on______________________________ (title of document(s)) dated __________________ and all power and authority granted thereby including powers for making health care decisions on my behalf and concerningRevocation I, ___________________________________ (Principal) maintaining an address at __________________________________________________ (address of Principal), hereby revoke my ____________________ion that is not state specific. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific instructions. Health Care Power of Attorney revoked. This revocation becomes effective immediately. Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general informate Power of Attorney Revocation is used by the Grantor to give notice that a previously granted Health Care Power of Attorney (sometimes referred to as a Living Will or Health Care Directive) has been alth Care Power of Attorney Revocation If the Grantor of a Health Care Power of Attorney decides to revoke the document, it is almost always required that the revocation be in writing. The Health Carfor you and should not be used without consulting with an attorney first. The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Information Hetify both. These forms are not intended and are not a substitute for legal advice. Laws are different from state to state and may change from time to time. These forms should only be a starting point e revocation document. If more than one document is being revoked, then each document needs to be identified i.e. if you are revoking a Health Care Power of Attorney and a Living Will, be sure to idenpies of the Health Care Power of Attorney so as to avoid any questions about the revocation or its effectiveness. The exact full title of the document(s) that you are revoking should be inserted in thon. In the event the original power of attorney was filed publicly (i.e. recorded), then the notice of revocation should also be filed publicly, in the same manner. The Principal should destroy any coceived a copy of the original Power of Attorney or who may have dealt with the Agent acting on behalf of the Principal. It is a good idea to keep a record of anyone who was sent a copy of the revocatio the Principal, the Agent or the Notary should not be a witness. The Principal should keep a copy of the revocation in his/her files. Copies of the revocation should be sent to anyone who may have reough not always required, it is always a good idea to also have two witnesses sign the Revocation of Power of Attorney. The witnesses should be adults. Generally, anyone related by blood or marriage tified mail receipt, delivery receipt etc..). Any health care providers need to be given a copy of the Revocation as well and copies of the revocation should be kept in any relevant medical files. Alth show that it was the Grantor's intent to revoke the Power of Attorney. If possible, the Principal should keep a copy of any document showing that the Agent received the original revocation (i.e. certd. Notarization is also necessary to record the revocation. This revocation becomes effective immediately. The original or a copy of the revocation must be given to the Agent (i.e. Attorney-inFact) tohe Health Care Power of Attorney Revocation before a Notary even if it is not required. Notarization will also help to ensure that the revocation is effective and support its authenticity if challengeer of Attorney Revocation (3) Health Care Power of Attorney Revocation The Principal (i.e. the person granting the Health Care Power of Attorney Revocation; sometimes called the Grantor) should sign tInstructions & Checklist Health Care Power of Attorney Revocation This package includes (1) Checklist & Instructions for Health Care Power of Attorney Revocation (2) Information about Health Care Pow OklahomaOklahoma -4- _____________________________________ (Witness Signature) Print Name: ___________________________________ Address: ______________________________________ __________________________________________________________________________ (Witness Signature) Print Name: ___________________________________ Address: ______________________________________ ______________________________________________ __________________________ (Signature) ___________________________________________________________ City, County and State of Residence -3- This advance directive was signed in my presence. _________________ understand the full importance of this living will and I am emotionally and mentally competent to make this living will. Signed this ___________ day of _____________, 20 _____. ______________________d. I understand that I may revoke this living will at any time. e. I understand and agree that if I have any prior living wills, and if I sign this living will, my prior living wills are revoked. f. Ieatment including, but not limited to, the administration of any life-sustaining procedures, and I accept the consequences of such refusal. c. This living will shall be in effect until it is revoked. the use of life-sustaining procedures, it is my intention that this living will shall be honored by my family and physicians as the final expression of my legal right to refuse medical or surgical trnt and that diagnosis is known to my attending physician, this living will shall have no force or effect during the course of my pregnancy. b. In the absence of my ability to give directions regardingrwise. ______________________________________________________________________________ _______________________ (signature) IV. General Provisions a. I understand that if I have been diagnosed as pregnainted a health care proxy through any other document, and if there is a conflict between my health care proxy's decision and my living will, my living will shall take precedence unless I indicate othe/lens, [___] glands, [___] other _____________ ______________ -2- _______________________ (signature) III. Conflicting Provision I understand that if I have completed both a living will and have appoorgans or parts: [___] lungs, [___] liver, [___] pancreas, [___] heart, [___] kidneys, [___] brain, [___] skin, [___] bones/marrow, [___] bloods/fluids, [___] tissue, [___] arteries, [___] eyes/corneairculatory and respiratory functions or irreversible cessation of all functions of the entire brain, including the brain stem. I specifically donate: [___] My entire body; or [___] The following body ransplantation, therapy, advancement of medical or dental science or research or education pursuant to the provisions of the Uniform Anatomical Gift Act. Death means either irreversible cessation of c_____________________ _______________________ (signature) II. Anatomical Gifts I direct that at the time of my death my entire body or designated body organs or body parts be donated for purposes of t_________________________________________________________________________ _________________________________________________________________________ ____________________________________________________orizing the withholding or withdrawal of artificially administered nutrition (food) and hydration (water). _______________________ (signature) (3) I direct that (add other medical directives, if any) portance. I understand that if I do not sign this paragraph, artificially administered nutrition and hydration will be administered to me. I further understand that if I sign this paragraph, I am auth (signature) (2) I understand that the subject of the artificial administration of nutrition and hydration (food and water) for individuals who have become persistently unconscious is of particular imaintain me in an irreversible condition, as determined by my attending -1- physician and another physician, in which thought and awareness of self and environment are absent. ___________________________________________ ______________________.(signature) c. If I am persistently unconscious: (1) I direct that life-sustaining treatment be withheld or withdrawn if such treatment will only serve to m___ (signature) (3) I direct that (add other medical directives, if any) _________________________________________________________________________ _____________________________________________________ered to me. I further understand that if I sign this paragraph, I am authorizing the withholding or withdrawal of artificially administered nutrition (food) and hydration (water). ____________________of dying from an incurable and irreversible condition is of particular importance. I understand that if I do not sign this paragraph, artificially administered nutrition and hydration will be administn six (6) months. _______________________ (signature) (2) I understand that the subject of the artificial administration of nutrition and hydration (food and water) that will only prolong the process d if my attending physician and another physician determine that I have an incurable and irreversible condition that even with the administration of life-sustaining treatment will cause my death withifort or to alleviate my pain. b. If I have a terminal condition: (1) I direct that life-sustaining treatment shall be withheld or withdrawn if such treatment would only prolong my process of dying, anntly Unconscious Act, to withhold or withdraw treatment from me under the circumstances I have indicated below by my signature. I understand that I will be given treatment that is necessary for my comI am no longer able to make decisions regarding my medical treatment, I direct my attending physician and other health care providers, pursuant to the Oklahoma Rights of the Terminally Ill or Persistel, that my life shall not be artificially prolonged under the circumstances set forth below. I thus do hereby declare: I. Living Will a. If my attending physician and another physician determine that _______________________________________, being of sound mind and eighteen (18) years of age or older, willfully and voluntarily make known my desire, by my instructions to others through my living wilnt should be discussed with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com -4- Living Will I, ________________ew it to make sure it fits your particular situation. You should also consult an attorney whenever a document is negotiated with another party. Any possible tax consequences arising out of this documee to state. These forms should only be a starting point for you and should not be used without consulting with an attorney first. Before using or signing this document you should have an attorney revity for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state advanced directive executed pursuant to the provisions of this section. [_] These forms are provided "as is" and no implied or express warranties have been made or are provided as to their suitabilited health care proxy, in lieu of an attending physician and other physician, to determine the lack of decisional capacity of the person. Such designation shall be specified and included as part of thdvanced directive appointing a health care proxy who may not have an attending physician for reasons based on established religious beliefs or tenets may designate an individual other than the designathority to make treatment decisions for the patient including the withholding or withdrawal of life-sustaining procedures if so indicated in the patient's advance directive. E. A person executing an aly with the advance directive, promptly so advise the Declarant. D. In the case of a qualified patient, the patient's health care proxy, in consultation with the attending physician, shall have the aulow) C. A physician or other health care provider who is furnished the original or a photocopy of the advance directive shall make it a part of the Declarant's medical record and, if unwilling to compd by two individuals who are eighteen (18) years of age or older who are not legatees, devisees or heirs at law. B. An advance directive shall be in substantially the following form: (Form included bes of age or older may execute at any time an advance directive governing the withholding or withdrawal of life-sustaining treatment. The advance directive shall be signed by the Declarant and witnesseth care provider shall make the revocation a part of the Declarant's medical record. -3- Section 3101.4 - Advance Directive Form and Procedures. A. An individual of sound mind and eighteen (18) yearndition. A revocation is effective upon communication to the attending physician or other health care provider by the Declarant or a witness to the revocation. B. The attending physician or other heal.6 - Revocation of Advance Directive. A. An advance directive may be revoked in whole or in part at any time and in any manner by the Declarant, without regard to the Declarant's mental or physical couted and not revoked, the last advance directive so executed shall be construed to be the last wishes of the Declarant and shall become operative pursuant to subsection A of this section. Section 3101 and other health care providers shall act in accordance with its provisions or comply with the provisions of Section 9 of this act. B. In the event more than one valid advance directive has been execttending physician; and 2. The Declarant is no longer able to make decisions regarding administration of lifesustaining treatment. When the advance directive becomes operative, the attending physician and another physician, result in death within six (6) months. Section 3101.5 - When Advance Directive Becomes Operative. A. An advance directive becomes operative when: 1. It is communicated to the aPuerto Rico; and 12. "Terminal condition" means an incurable and irreversible condition that, even with the administration of life-sustaining treatment, will, in the opinion of the attending physicianthe attending physician and another physician who have examined the patient; 11. "State" means a state, territory, or possession of the United States, the District of Columbia, or the Commonwealth of patient" means a patient eighteen (18) years of age or older who has executed an advance directive and who has been determined to be in a terminal condition or in a persistently unconscious state by , joint venture, government, governmental subdivision or agency, or any other legal or commercial entity; 9. "Physician" means an individual licensed to practice medicine in this state; 10. "Qualifiedan and another physician, in which thought and awareness of self and environment are absent; -2- 8. "Person" means an individual, corporation, business trust, estate, trust, partnership, associationmedical treatment deemed necessary to alleviate pain nor the normal consumption of food and water; 7. "Persistently unconscious" means an irreversible condition, as determined by the attending physiciess of dying or to maintain the patient in a condition of persistent unconsciousness. The term "life-sustaining treatment" shall not include the administration of medication or the performance of any ant has specifically authorized the withholding and withdrawal of artificially administered nutrition and hydration, that, when administered to a qualified patient, will serve only to prolong the procapable of communication; 6. "Life-sustaining treatment" means any medical procedure or intervention, including but not limited to the artificial administration of nutrition and hydration if the Declar of life-sustaining treatment if a qualified patient, in the opinion of the attending physician and another physician, is persistently unconscious, incompetent, or otherwise mentally or physically incth care proxy" is an individual eighteen (18) years old or older appointed by the Declarant as attorney-in-fact to make health care decisions including but not limited to the withholding or withdrawalprovider" means a person who is licensed, certified, or otherwise authorized by the law of this state to administer health care in the ordinary course of business or practice of a profession; 5. "Healty for the treatment and care of the patient; 3. "Declarant" means any individual who has issued an advance directive according to the procedure provided for in Section 4 of this act; 4. "Health care ct and may include a living will, the appointment of a health care proxy, or both such living will and appointment of a proxy; 2. "Attending physician" means the physician who has primary responsibili the Oklahoma Rights of the Terminally Ill or Persistently Unconscious Act: 1. "Advance directive for health care" means any writing executed in accordance with the requirements of Section 4 of this aOklahoma Rights of the Terminally Ill or Persistently Unconscious Act does not condone, authorize, or approve mercy killing, assisted suicide, or euthanasia. Section 3101.3 - Terms Defined. As used in -1- includes necessary and appropriate protection for proxies and health care providers who rely in good faith on the instructions of the individual and the decisions of an authorized proxy. C. The th care proxy. B. To be sure that the individual's health care instructions and proxy decision-making will be effective, the Oklahoma Rights of the Terminally Ill or Persistently Unconscious Act also red during incapacity without court involvement; and 5. Encourage and support health care instructions by the individual in advance of incapacity and the delegation of decision-making powers to a healother proxy is authorized by the individual or is otherwise authorized by law; 4. Restate and clarify the law to ensure that the individual's advance directive for health care will continue to be honoindividual's values and what the individual's wishes would be based upon those values. The proper role of the court is to settle disputes and to act as the proxy decision-maker of last resort when no s wishes is sufficient, those wishes should control; if there is not sufficient evidence of the individual's wishes, the proxy's decisions should be based on the proxy's reasonable judgment about the is incapacitated, so long as a proxy decision-maker can make the necessary decisions based on the known intentions, personal views, or best interests of the individual. If evidence of the individual'render care or to preserve life and health; 3. Recognize that decisions concerning one's medical treatment involve highly sensitive, personal issues that do not belong in court, even if the individualals to control some aspects of their own medical treatment is protected by the Constitution of the United States and overrides any obligation the physician and other health care providers may have to eir own medical care and treatment, including but not limited to the right to decline medical treatment or to direct that it be withdrawn, even if death ensues; 2. Recognize that the right of individue Form. Section 3101.2 - Purpose. A. The purpose of the Oklahoma Rights of the Terminally Ill or Persistently Unconscious Act is to: 1. Recognize the right of individuals to control some aspects of thart on Title 63; Chapter 60; Section 3101.2 et. Seq. of the on Oklahoma Statutes. The following are useful excerpts from the Oklahoma Statutes relating to the Oklahoma Power of Attorney for Health CarInformation and Instructions Oklahoma Living Will This package contains (1) Information and Instruction for Oklahoma Living Will; (2) Oklahoma Living Will Form. This Oklahoma Living Will is based in p OklahomaOklahoma ___________________________________________ -4- _________________________________ _____________________________________________ (Witness Signature) Print Name: ___________________________________ Address: ______________________________________ ___ signed in my presence. _____________________________________________ (Witness Signature) Print Name: ___________________________________ Address: ______________________________________ __________________, 20 _____. -3- ________________________________________ (Signature) ___________________________________________________________ City, County and State of Residence This Health Care Proxy wase Proxies are revoked. f. I understand the full importance of this Health Care Proxy and I am emotionally and mentally competent to make this Health Care Proxy. Signed this ___________ day of ________ d. I understand that I may revoke this Health Care Proxy at any time. e. I understand and agree that if I have any prior Health Care Proxies, and if I sign this Health Care Proxy, my prior Health Carnt including, but not limited to, the administration of any life-sustaining procedures, and I accept the consequences of such refusal. c. This Health Care Proxy shall be in effect until it is revoked. life-sustaining procedures, it is my intention that this advance directive shall be honored by my family and physicians as the final expression of my legal right to refuse medical or surgical treatmes is known to my attending physician, any directives give by me shall have no force or effect during the course of my pregnancy. b. In the absence of my ability to give directions regarding the use of________________________________________________________________ _______________________ (signature) IV. General Provisions a. I understand that if I have been diagnosed as pregnant and that diagnosie appointed a health care proxy, and if there is a conflict between my health care proxy's decision and my living will, my living will shall take precedence unless I indicate otherwise. ______________yes/cornea/lens, [___] glands, [___] other _____________ ______________ _______________________ (signature) III. Conflicting Provision I understand that if I have completed both a living will and havody organs or parts: [___] lungs, [___] liver, [___] pancreas, [___] heart, [___] kidneys, [___] brain, [___] skin, [___] bones/marrow, [___] bloods/fluids, [___] tissue, -2- [___] arteries, [___] eof circulatory and respiratory functions or irreversible cessation of all functions of the entire brain, including the brain stem. I specifically donate: [___] My entire body; or [___] The following bof transplantation, therapy, advancement of medical or dental science or research or education pursuant to the provisions of the Uniform Anatomical Gift Act. Death means either irreversible cessation ________________________ _______________________ (signature) II. Anatomical Gifts I direct that at the time of my death my entire body or designated body organs or body parts be donated for purposes y) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________g the withholding and withdrawal of artificially administered nutrition and hydration. _______________________ (signature) (3) I authorize my health care proxy to (add other medical directives, if and that if I do not sign this paragraph, artificially administered nutrition (food) and hydration (water) will be administered to me. I further understand that if I sign this paragraph, I am authorizin are absent. _______________________ (signature) (2) I understand that the subject of the artificial administration of nutrition and hydration (food and water) is of particular importance. I understanawn if such treatment will only serve to maintain me in an irreversible condition, as determined by my attending physician and another physician, in which thought and awareness of self and environment _______________________ (signature) c. If I am persistently unconscious (sign if applicable): -1- (1) I authorize my health care proxy to direct that life-sustaining treatment be withheld or withdrcare proxy to (add other medical directives, if any) _________________________________________________________________________ _________________________________________________________________________tand that if I sign this paragraph, I am authorizing the withholding or withdrawal of artificially administered nutrition and hydration. _______________________ (signature) (3) I authorize my health and water) is of particular importance. I understand that if I do not sign this paragraph, artificially administered nutrition (food) or hydration (water) will be administered to me. I further unders-sustaining treatment will cause my death within six (6) months. _______________________ (signature) (2) I understand that the subject of the artificial administration of nutrition and hydration (foodtment would only prolong my process of dying and if my attending physician and another physician determine that I have an incurable and irreversible condition that even with the administration of lifee in the following sections. b. If I have a terminal condition (sign if applicable): (1) I authorize my health care proxy to direct that life-sustaining treatment be withheld or withdrawn if such trear medical treatment decisions I could make if I were able, except that decisions regarding lifesustaining treatment can be made by my health care proxy or alternate health care proxy only as I indicatnable or unwilling to serve, I appoint ___________________________________________________ as my alternate health care proxy with the same authority. My health care proxy is authorized to make whatevehe Terminally Ill or Persistently Unconscious Act to follow the instructions of __________________________________________________, whom I appoint as my health care proxy. If my health care proxy is uther physician determine that I am no longer able to make decisions regarding my medical treatment, I direct my attending physician and other health care providers pursuant to the Oklahoma Rights of tr, willfully and voluntarily make known my desires and my wish to appoint a health care proxy. I thus do hereby declare: I. My Appointment of My Health Care Proxy a. If my attending physician and ano Disclaimers and Terms of Use found at findlegalforms.com -4- Health Care Proxy I, _______________________________________________________, being of sound mind and eighteen (18) years of age or oldement is negotiated with another party. Any possible tax consequences arising out of this document should be discussed with a tax professional. [_] The purchase and use of these forms is subject to the with an attorney first. Before using or signing this document you should have an attorney review it to make sure it fits your particular situation. You should also consult an attorney whenever a docuand are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used without consultings is" and no implied or express warranties have been made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended cisional capacity of the person. Such designation shall be specified and included as part of the advanced directive executed pursuant to the provisions of this section. [_] These forms are provided "ad on established religious beliefs or tenets may designate an individual other than the designated health care proxy, in lieu of an attending physician and other physician, to determine the lack of deining procedures if so indicated in the patient's advance directive. E. A person executing an advanced directive appointing a health care proxy who may not have an attending physician for reasons basehe patient's health care proxy, in consultation with the attending physician, shall have the authority to make treatment decisions for the patient including the withholding or withdrawal of life-sustaance directive shall make it a part of the Declarant's medical record and, if unwilling to comply with the advance directive, promptly so advise the Declarant. D. In the case of a qualified patient, tat law. B. An advance directive shall be in substantially the following form: (Form included below) C. A physician or other health care provider who is furnished the original or a photocopy of the adv life-sustaining treatment. The advance directive shall be signed by the Declarant and witnessed by two individuals who are eighteen (18) years of age or older who are not legatees, devisees or heirs - Advance Directive Form and Procedures. A. An individual of sound mind and eighteen (18) years of age or older may execute at any time an advance directive governing the withholding or withdrawal ofvider by the Declarant or a witness to the revocation. B. The attending physician or other health care provider shall make the revocation a part of the Declarant's medical record. -3- Section 3101.4ime and in any manner by the Declarant, without regard to the Declarant's mental or physical condition. A revocation is effective upon communication to the attending physician or other health care prohe Declarant and shall become operative pursuant to subsection A of this section. Section 3101.6 - Revocation of Advance Directive. A. An advance directive may be revoked in whole or in part at any t of Section 9 of this act. B. In the event more than one valid advance directive has been executed and not revoked, the last advance directive so executed shall be construed to be the last wishes of tfesustaining treatment. When the advance directive becomes operative, the attending physician and other health care providers shall act in accordance with its provisions or comply wit h the provisionsmes Operative. A. An advance directive becomes operative when: 1. It is communicated to the attending physician; and 2. The Declarant is no longer able to make decisions regarding administration of liadministration of life-sustaining treatment, will, in the opinion of the attending physician and another physician, result in death within six (6) months. Section 3101.5 - When Advance Directive Becoitory, or possession of the United States, the District of Columbia, or the Commonwealth of Puerto Rico; and 12. "Terminal condition" means an incurable and irreversible condition that, even with the has been determined to be in a terminal condition or in a persistently unconscious state by the attending physician and another physician who have examined the patient; 11. "State" means a state, terr "Physician" means an individual licensed to practice medicine in this state; 10. "Qualified patient" means a patient eighteen (18) years of age or older who has executed an advance directive and who n" means an individual, corporation, business trust, estate, trust, partnership, association, joint venture, government, governmental subdivision or agency, or any other legal or commercial entity; 9.stently unconscious" means an irreversible condition, as determined by the attending physician and another physician, in which thought and awareness of self and environment are absent; -2- 8. "Persoing treatment" shall not include the administration of medication or the performance of any medical treatment deemed necessary to alleviate pain nor the normal consumption of food and water; 7. "Persidration, that, when administered to a qualified patient, will serve only to prolong the process of dying or to maintain the patient in a condition of persistent unconsciousness. The term "life-sustainng but not limited to the artificial administration of nutrition and hydration if the Declarant has specifically authorized the withholding and withdrawal of artificially administered nutrition and hyphysician, is persistently unconscious, incompetent, or otherwise mentally or physically incapable of communication; 6. "Life-sustaining treatment" means any medical procedure or intervention, includiact to make health care decisions including but not limited to the withholding or withdrawal of life-sustaining treatment if a qualified patient, in the opinion of the attending physician and another nister health care in the ordinary course of business or practice of a profession; 5. "Health care proxy" is an individual eighteen (18) years old or older appointed by the Declarant as attorney- in-firective according to the procedure provided for in Section 4 of this act; 4. "Health care provider" means a person who is licensed, certified, or otherwise authorized by the law of this state to admitment of a proxy; 2. "Attending physician" means the physician who has primary responsibility for the treatment and care of the patient; 3. "Declarant" means any individual who has issued an advance dcare" means any writing executed in accordance with the requirements of Section 4 of this act and may include a living will, the appointment of a health care proxy, or both such living will and appoinmercy killing, assisted suicide, or euthanasia. Section 3101.3 - Terms Defined. As used in the Oklahoma Rights of the Terminally Ill or Persistently Unconscious Act: 1. "Advance directive for health th on the instructions of the individual and the decisions of an authorized proxy. C. The Oklahoma Rights of the Terminally Ill or Persistently Unconscious Act does not condone, authorize, or approve effective, the Oklahoma Rights of the Terminally Ill or Persistently Unconscious Act also -1- includes necessary and appropriate protection for proxies and health care providers who rely in good faidividual in advance of incapacity and the delegation of decision- making powers to a health care proxy. B. To be sure that the individual's health care instructions and proxy decision- making will be ensure that the individual's advance directive for health care will continue to be honored during incapacity without court involvement; and 5. Encourage and support health care instructions by the inrt is to settle disputes and to act as the proxy decision- maker of last resort when no other proxy is authorized by the individual or is otherwise authorized by law; 4. Restate and clarify the law toes, the proxy's decisions should be based on the proxy's reasonable judgment about the individual's values and what the individual's wishes would be based upon those values. The proper role of the couns, personal views, or best interests of the individual. If evidence of the individual's wishes is sufficient, those wishes should control; if there is not sufficient evidence of the individual's wish highly sensitive, personal issues that do not belong in court, even if the individual is incapacitated, so long as a proxy decision- maker can make the necessary decisions based on the known intentiond overrides any obligation the physician and other health care providers may have to render care or to preserve life and health; 3. Recognize that decisions concerning one's medical treatment involvect that it be withdrawn, even if death ensues; 2. Recognize that the right of individuals to control some aspects of their own medical treatment is protected by the Constitution of the United States anscious Act is to: 1. Recognize the right of individuals to control some aspects of their own medical care and treatment, including but not limited to the right to decline medical treatment or to dire from the Oklahoma Statutes relating to the Oklahoma Power of Attorney for Health Care Form. Section 3101.2 - Purpose. A. The purpose of the Oklahoma Rights of the Terminally Ill or Persistently Uncorney for Health Care Form. This Oklahoma Power of Attorney for Health Care is based in part on Title 63; Chapter 60; Section 3101.2 et. Seq. of the Oklahoma Statutes. The following are useful excerptsInformation and Instructions Oklahoma Power of Attorney for Health Care This package contains (1) Information and Instruction for Oklahoma Power of Attorney for Health Care; (2) Oklahoma Power of Atto OklahomaOklahoma _________________ Name: _______________________________________________ Address: ____________________________________________ City: _______________________________________________ State: ______________________________: _______________________________________________ State: _______________________________________________ SECOND WITNESS: Date: __________________ Signature: ___________________________________________ITNESS: Date: __________________ Signature: ___________________________________________ Name: _______________________________________________ Address: ____________________________________________ Cityion and in the presence of the Donor and each other. The individual signing the Donation of Gift was directed to do so by the Donor and signed the document in his/her presence as well as ours. FIRST Wnd by two witnesses, all of whom have signed at the direction and in the presence of the donor and of each other, and state that it has been so signed.] Witness Statement: We have signed at the direct____________________ WITNESS FORM [An anatomical gift may be made only by a document of gift signed by the donor. If the donor cannot sign, the document of gift must be signed by another individual a_ Print your name: ______________________________________ Address: ____________________________________________ City: _______________________________________________ State: ___________________________n, surgeon, technician, or enucleator to carry out the appropriate procedures. SIGNATURE: (Sign and date the form here:) Date: __________________ Sign your name: _____________________________________the appropriate procedures. In the absence of a designation or if the designee is not available, the donee or other person authorized to accept the anatomical gift may employ or authorize any physiciaof the following you do not want): (1) Transplant (2) Therapy (3) Research (4) Education (Optional) I designate ___________________________________ as my particular physician or surgeon to carry out __ ________________________________________________________________________ ________________________________________________________________________ My gift is for the following purposes (strike any x): Give any needed organs, tissues, or parts, OR Give the following organs, tissues, or parts only: ____________________________ ______________________________________________________________________ for all serious legal matters. Anatomical Gift by Living Donor Pursuant to Uniform Anatomical Gift Act Upon my death, I ____________________________________ (the "Donor"), hereby (mark applicable boand on any theory of liability, whether in contract, strict liability, or tort (including negligence or otherwise) arising in any way out of the use of these materials. An attorney should be consultedntal, special, exemplary, or consequential damages (including, but not limited to, procurement of substitute goods or services; loss of use, data, or profits; or business interruption) however caused risk. In no event will: i) FindLegalForms, Inc, its agents, partners, or affiliates, or ii) the providers, authors or publishers of the forms, be responsible or liable for any direct, indirect, incideovided "AS-IS." We do not give any express or implied warranties of merchantability, suitability or completeness for any of the materials for your particular needs. The materials are used at your own erials. FindLegalForms, Inc. does not provide legal advice. The purchase and use of these materials is subject to the "Disclaimers and Terms of Use" found at findlegalforms.com. These materials are pran anatomical gift. During a terminal illness or injury, the refusal may be an oral statement or other form of communication. Disclaimer No Attorney-Client relationship is created by use of these matocument of gift, (ii) a statement attached to or imprinted on a donor's motor vehicle operator's or chauffeur's license, or (iii) any other writing used to identify the individual as refusing to make the consent or concurrence of any person after the donor's death. An individual may refuse to make an anatomical gift of the individual's body or part by (i) a writing signed in the same manner as a ddelivery of a signed statement to a specified donee to whom a document of gift had been delivered. An anatomical gift that is not revoked by the donor before death is irrevocable and does not require ) a signed statement; (2) an oral statement made in the presence of two individuals; (3) any form of communication during a terminal illness or injury addressed to a physician or surgeon; or (4) the f, after death, the will is declared invalid for testamentary purposes, the validity of the anatomical gift is unaffected. A donor may amend or revoke an anatomical gift, not made by will, only by: (1ze any physician, surgeon, technician, or enucleator to carry out the appropriate procedures. An anatomical gift by will takes effect upon death of the testator, whether or not the will is probated. In to carry out the appropriate procedures. In the absence of a designation or if the designee is not available, the donee or other person authorized to accept the anatomical gift may employ or authories, all of whom have signed at the direction and in the presence of the donor and of each other, and state that it has been so signed. A document of gift may designate a particular physician or surgeo least 18 years of age. An anatomical gift may be made by a document of gift signed by the donor. If the donor cannot sign, the document of gift must be signed by another individual and by two witness Instructions for preparing your Anatomical Gift Anatomical Gift Form To make an anatomical gift, limit an anatomical gift or refuse to make an anatomical gift, an individual must in most cases be atvides tools and guidelines to assist you in creating your Anatomical Gift and is designed to fulfill the obligations of the Uniform Anatomical Gift Act. Included in this kit are the following: Generalour wishes regarding the disposition of your body will be ignored. By preparing a written Anatomical Gift, you can rest assured that your desire to donate your organs will be carried out. This kit proFindLegalForms.com Information Donation Pursuant to the Uniform Anatomical Gift Act (by Living Donor) No one likes considering their own death, but by avoiding the subject, it is likely that many of y OklahomaOklahoma ________ n whose name is subscribed to this instrument appears to be of sound mind and under no duress, fraud, or undue influence. _____________________________ Notary Public My commission expires ____________ersonally and, under oath, stated that he or she is the person described in the above document and he or she signed the above document in my presence. I declare under penalty of perjury that the perso_________________________________ Notary Acknowledgment (Optional) State of ____________________ County of ____________________ On ____________________, ______________________________ came before me pignature of Donor ______________________________ Printed Name of Donor Address: ____________________________________________ City: _______________________________________________ State: ______________y written revocation of my Anatomical Gift. This statement will be delivered to all specified donees, if any, to whom a document of gift had been previously delivered. ______________________________ Sication during a terminal illness or injury addressed to a physician or surgeon; or (4) the delivery of a signed statement to a specified donee to whom a document of gift had been delivered. This is m of this state, a donor may amend or revoke an anatomical gift, not made by will, only by: (1) a signed statement; (2) an oral statement made in the presence of two individuals; (3) any form of commun__________________, I, ______________________________, the donor, fully and completely revoke the Anatomical Gift dated __________________________. Pursuant to Uniform Anatomical Gift Act and the lawsft Act, you should check the laws of your state to determine whether there are any other requirements you must meet to revoke your Anatomical Gift. Revocation of Anatomical Gift On this date ________estroy the original and all copies of your Anatomical Gift or cross out each page of the forms and mark "REVOKED" across them in bold print. Although most states have adopted the Uniform Anatomical Giorm notarized. You should also make certain that a copy of any revocation is provided to anyone who has a copy of your original Anatomical Gift, including any designated donees. You should also then dted. When you have completed the form and printed it, sign the form and make certain that you store the original where you had stored the original of your Anatomical Gift. You may choose to have the f. An anatomical gift that is not revoked by the donor before death is irrevocable and does not require the consent or concurrence of any person after the donor's death. Complete the information requesm of communication during a terminal illness or injury addressed to a physician or surgeon; or (4) the delivery of a signed statement to a specified donee to whom a document of gift had been deliveredn of Anatomical Gift form. A donor may amend or revoke an anatomical gift, not made by will, only by: (1) a signed statement; (2) an oral statement made in the presence of two individuals; (3) any foray out of the use of these materials. An attorney should be consulted for all serious legal matters. Revoking Your Anatomical Gift Instructions Following these instructions, you will find a Revocatios of use, data, or profits; or business interruption) however caused and on any theory of liability, whether in contract, strict liability, or tort (including negligence or otherwise) arising in any w the forms, be responsible or liable for any direct, indirect, incidental, special, exemplary, or consequential damages (including, but not limited to, procurement of substitute goods or services; loserials for your particular needs. The materials are used at your own risk. In no event will: i) FindLegalForms, Inc, its agents, partners, or affiliates, or ii) the providers, authors or publishers ofand Terms of Use" found at findlegalforms.com. These materials are provided "AS-IS." We do not give any express or implied warranties of merchantability, suitability or completeness for any of the matlaimer No Attorney-Client relationship is created by use of these materials. FindLegalForms, Inc. does not provide legal advice. The purchase and use of these materials is subject to the "Disclaimers esigned to fulfill the requirements of the Uniform Anatomical Gift Act. Included in this kit is the following: General Instructions for Revoking Your Anatomical Gift Revocation of Anatomical Gift Discnt to revoke the document. Until your death, it is your right to revoke your Anatomical Gift at any time. This kit provides tools and guidelines to assist you in revoking your Anatomical Gift and is dFindLegalForms.com Information Revoking an Anatomical Gift (Organ Donation Revocation) You prepared a written Anatomical Gift, but now because of a change of circumstances or a change of heart, you wa OklahomaOklahoma _____________ Name of Survivor: _______________________________ Address: ____________________________________________ City: _______________________________________________ State: __________________________________urposes (strike any of the following you do not want): (1) Transplant (2) Therapy (3) Research (4) Education Date: __________________ Signature of Survivor: __________________________________ Printed_______________ ________________________________________________________________________ ________________________________________________________________________ III. The gift is for the following pthe applicable box): Give any needed organs, tissues, or parts, OR Give the following organs, tissues, or parts only: _______________________ _________________________________________________________ity and state). I. I survive the decedent as (mark the appropriate box): spouse; adult son or daughter; parent; adult brother or sister; grandparent; or guardian of the decedent. II. I hereby (mark this anatomical gift from the body of __________________________________(name of decedent) who died on _____________, 20___ at_______________________________ in ____________________________________ (corney should be consulted for all serious legal matters. Anatomical Gift by Next of Kin or Guardian of the Person Pursuant to the Uniform Anatomical Gift Act and the law of this state, I hereby make rruption) however caused and on any theory of liability, whether in contract, strict liability, or tort (including negligence or otherwise) arising in any way out of the use of these materials. An att direct, indirect, incidental, special, exemplary, or consequential damages (including, but not limited to, procurement of substitute goods or services; loss of use, data, or profits; or business inteals are used at your own risk. In no event will: i) FindLegalForms, Inc, its agents, partners, or affiliates, or ii) the providers, authors or publishers of the forms, be responsible or liable for anym. These materials are provided "AS-IS." We do not give any express or implied warranties of merchantability, suitability or completeness for any of the materials for your particular needs. The materieated by use of these materials. FindLegalForms, Inc. does not provide legal advice. The purchase and use of these materials is subject to the "Disclaimers and Terms of Use" found at findlegalforms.con for the removal of a part from the body of the decedent, the physician, surgeon, technician, or enucleator removing the part knows of the revocation. Disclaimer No Attorney-Client relationship is cr a member of the person's class or a prior class. An anatomical gift by a person authorized under subdivision may be revoked by any member of the same or a prior class if, before procedures have beguoposing to make an anatomical gift knows of a refusal or contrary indications by the decedent. (3) The person proposing to make an anatomical gift knows of an objection to making an anatomical gift byAn anatomical gift may not be made by a person listed above if any of the following occur: (1) A person in a prior class is available at the time of death to make an anatomical gift. (2) The person pre decedent; (3) either parent of the decedent; (4) an adult brother or sister of the decedent; (5) a grandparent of the decedent; and (6) a guardian of the person of the decedent at the time of death ker for an authorized purpose, unless the decedent, at the time of death, has made an unrevoked refusal to make that anatomical gift: (1) the spouse of the decedent; (2) an adult son or daughter of th Gift Form An anatomical gift may be made any member of the following classes of persons, in the order of priority listed, may make an anatomical gift of all or part of the decedent's body or a pacemas made on behalf of the decedent by the next of kin or guardian. Included in this kit are the following: General Instructions for preparing your Anatomical Gift (by next of kin or guardian) Anatomicalt. As the next of kin or guardian, you can prepare and execute an Anatomical Gift on behalf of the decedent. This kit is designed to fulfill the obligations of the Uniform Anatomical Gift Act for giftFindLegalForms.com Information Donation Pursuant to the Uniform Anatomical Gift Act (by Next of Kin or Guardian) A loved one has died and you believe that he/she would desire to make an Anatomical Gif Oklahoma