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To amend sections 2108.72 and 2108.73 of the Revised | 1 |
Code to allow a DD Form 93, Record of Emergency | 2 |
Data, to satisfy the written declaration | 3 |
requirements for designating a person authorized | 4 |
to direct disposition of human remains. | 5 |
Section 1. That sections 2108.72 and 2108.73 of the Revised | 6 |
Code be amended to read as follows: | 7 |
Sec. 2108.72. (A) The written declaration described in | 8 |
section 2108.70 of the Revised Code shall include all of the | 9 |
following: | 10 |
(1) The declarant's legal name and present address; | 11 |
(2) A statement that the declarant, an adult being of sound | 12 |
mind, willfully and voluntarily appoints a representative to have | 13 |
the declarant's right of disposition for the declarant's body upon | 14 |
the declarant's death; | 15 |
(3) A statement that all decisions made by the declarant's | 16 |
representative with respect to the right of disposition are | 17 |
binding; | 18 |
(4) The name, last known address, and last known telephone | 19 |
number of the representative or, if the representative is a group | 20 |
of persons, the name, last known address, and last known telephone | 21 |
number of each person in the group; | 22 |
(5) If the declarant chooses to have a successor | 23 |
representative, a statement that if any person or group of persons | 24 |
named as the declarant's representative is disqualified from | 25 |
serving in such position as described in section 2108.75 of the | 26 |
Revised Code, the declarant appoints a successor representative; | 27 |
(6) If applicable, the name, last known address, and last | 28 |
known telephone number of the successor representative or, if the | 29 |
successor representative is a group of persons, the name, last | 30 |
known address, and last known telephone number of each person in | 31 |
the group; | 32 |
(7) A space where the declarant may indicate the declarant's | 33 |
preferences regarding how the right of disposition should be | 34 |
exercised, including any religious observances the declarant | 35 |
wishes the person with the right of disposition to consider; | 36 |
(8) A space where the declarant may indicate one or more | 37 |
sources of funds that may be used to pay for goods and services | 38 |
associated with the exercise of the right of disposition; | 39 |
(9) A statement that the declarant's written declaration | 40 |
becomes effective on the declarant's death; | 41 |
(10) A statement that the declarant revokes any written | 42 |
declaration that the declarant executed, in accordance with | 43 |
section 2108.70 of the Revised Code, prior to the execution of the | 44 |
present written declaration | 45 |
(11) A space where the declarant can sign and date the | 46 |
written declaration; | 47 |
(12) A space where a notary public or two witnesses can sign | 48 |
and date the written declaration as described in section 2108.73 | 49 |
of the Revised Code. | 50 |
(B) A written declaration may take the following form: | 51 |
APPOINTMENT OF REPRESENTATIVE FOR DISPOSITION OF BODILY | 52 |
REMAINS, FUNERAL ARRANGEMENTS, AND BURIAL OR CREMATION GOODS AND | 53 |
SERVICES: | 54 |
I, ................. (legal name and present address of | 55 |
declarant), an adult being of sound mind, willfully and | 56 |
voluntarily appoint my representative, named below, to have the | 57 |
right of disposition, as defined in section 2108.70 of the Revised | 58 |
Code, for my body upon my death. All decisions made by my | 59 |
representative with respect to the right of disposition shall be | 60 |
binding. | 61 |
REPRESENTATIVE: | 62 |
(If the representative is a group of persons, indicate the | 63 |
name, last known address, and telephone number of each person in | 64 |
the group.) | 65 |
Name(s): | 66 | ||||
Address(es): | 67 | ||||
Telephone Number(s): | 68 |
SUCCESSOR REPRESENTATIVE: | 69 |
If my representative is disqualified from serving as my | 70 |
representative as described in section 2108.75 of the Revised | 71 |
Code, then I hereby appoint the following person or group of | 72 |
persons to serve as my successor representative. | 73 |
(If the successor representative is a group of persons, | 74 |
indicate the name, last known address, and telephone number of | 75 |
each person in the group.) | 76 |
Name(s): | 77 | ||||
Address(es): | 78 | ||||
Telephone Number(s): | 79 |
PREFERENCES REGARDING HOW THE RIGHT OF DISPOSITION SHOULD BE | 80 |
EXERCISED, INCLUDING ANY RELIGIOUS OBSERVANCES THE DECLARANT | 81 |
WISHES A REPRESENTATIVE OR A SUCCESSOR REPRESENTATIVE TO CONSIDER: | 82 |
83 | |
84 | |
85 | |
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ONE OR MORE SOURCES OF FUNDS THAT COULD BE USED TO PAY FOR | 87 |
GOODS AND SERVICES ASSOCIATED WITH AN EXERCISE OF THE RIGHT OF | 88 |
DISPOSITION: | 89 |
90 | |
91 | |
92 | |
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DURATION: | 94 |
The appointment of my representative and, if applicable, | 95 |
successor representative, becomes effective upon my death. | 96 |
PRIOR APPOINTMENTS REVOKED: | 97 |
I hereby revoke any written declaration that I executed in | 98 |
accordance with section 2108.70 of the Ohio Revised Code prior to | 99 |
the date of execution of this written declaration indicated below. | 100 |
AUTHORIZATION TO ACT: | 101 |
I hereby agree that any of the following that receives a copy | 102 |
of this written declaration may act under it: | 103 |
- Cemetery organization; | 104 |
- Crematory operator; | 105 |
- Business operating a columbarium; | 106 |
- Funeral director; | 107 |
- Embalmer; | 108 |
- Funeral home; | 109 |
- Any other person asked to assist with my funeral, burial, | 110 |
cremation, or other manner of final disposition. | 111 |
MODIFICATION AND REVOCATION - WHEN EFFECTIVE: | 112 |
Any modification or revocation of this written declaration is | 113 |
not effective as to any party until that party receives actual | 114 |
notice of the modification or revocation. | 115 |
LIABILITY: | 116 |
No person who acts in accordance with a properly executed | 117 |
copy of this written declaration shall be liable for damages of | 118 |
any kind associated with the person's reliance on this | 119 |
declaration. | 120 |
Signed this ...... day of ....... | 121 | ||
122 | |||
(Signature of declarant) | 123 |
ACKNOWLEDGMENT OF ASSUMPTION OF OBLIGATIONS AND COSTS: | 124 |
By signing below, the representative, or successor | 125 |
representative, if applicable, acknowledges that he or she, as | 126 |
representative or successor representative, assumes the right of | 127 |
disposition as defined in section 2108.70 of the Revised Code, and | 128 |
understands that he or she is liable for the reasonable costs of | 129 |
exercising the right, including any goods and services that are | 130 |
purchased. | 131 |
ACCEPTANCE (OPTIONAL): | 132 |
The undersigned hereby accepts this appointment as | 133 |
representative or successor representative, as applicable, for the | 134 |
right of disposition as defined in section 2108.70 of the Revised | 135 |
Code. | 136 |
Signed this ...... day of ....... | 137 | ||
138 | |||
Signature of representative (if representative is a group of persons, each person in the group shall sign) | 139 | ||
Signed this ...... day of ....... | 140 | ||
141 | |||
Signature of successor representative (if successor representative is a group of persons, each person in the group shall sign) | 142 |
WITNESSES: | 143 |
I attest that the declarant signed or acknowledged this | 144 |
assignment of the right of disposition under section 2108.70 of | 145 |
the Revised Code in my presence and that the declarant is at least | 146 |
eighteen years of age and appears to be of sound mind and not | 147 |
under or subject to duress, fraud, or undue influence. I further | 148 |
attest that I am not the declarant's representative or successor | 149 |
representative, I am at least eighteen years of age, and I am not | 150 |
related to the declarant by blood, marriage, or adoption. | 151 |
First witness: | 152 | ||||
Name (printed): | 153 | ||||
Residing at: | 154 | ||||
Signature: | 155 | ||||
156 | |||||
Date: | 157 | ||||
158 | |||||
Second witness: | 159 | ||||
Name (printed): | 160 | ||||
Residing at: | 161 | ||||
Signature: | 162 | ||||
163 | |||||
Date: | 164 | ||||
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OR | 166 |
NOTARY ACKNOWLEDGMENT: | 167 |
State of Ohio | 168 |
County of ............. SS. | 169 |
On ..............., before me, the undersigned notary public, | 170 |
personally appeared ................., known to me or | 171 |
satisfactorily proven to be the person whose name is subscribed as | 172 |
the declarant, and who has acknowledged that he or she executed | 173 |
this written declaration under section 2108.70 of the Revised Code | 174 |
for the purposes expressed in that section. I attest that the | 175 |
declarant is at least eighteen years of age and appears to be of | 176 |
sound mind and not under or subject to duress, fraud, or undue | 177 |
influence. | 178 |
Signature of notary public | 179 | ||
180 | |||
My commission expires on: | 181 | ||
182 |
(C) Completion of a DD Form 93, Record of Emergency Data, is | 183 |
sufficient to constitute a written declaration under section | 184 |
2108.70 of the Revised Code. | 185 |
Sec. 2108.73. A written declaration executed by a declarant | 186 |
under section 2108.70 of the Revised Code shall be signed and | 187 |
dated by the declarant in the presence of | 188 |
following: | 189 |
(A) A notary public who shall make the certification | 190 |
described in section 147.53 of the Revised Code. | 191 |
(B) Two witnesses who are adults and who are not related by | 192 |
blood, marriage, or adoption to the declarant. | 193 |
(C) If the written declaration is a DD Form 93, Record of | 194 |
Emergency Data, by whomever the form requires. | 195 |
Section 2. That existing sections 2108.72 and 2108.73 of the | 196 |
Revised Code are hereby repealed. | 197 |